The dynamics of the metabolism of acetate and bicarbonate associated with use of hemodialysates in the ABChD trial

A phase IV, prospective, single center, single blind, randomized, cross-over, two week investigation

William Smith, Sandy Gibson, George E. Newman, Kendra S. Hendon, Margarita Askelson, James Zhao, Jamil Hantash, Brigid Flanagan, John W. Larkin, Len A. Usvyat, Ravi I. Thadhani, Franklin W. Maddux

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: In the United States, hemodialysis (HD) is generally performed via a bicarbonate dialysate. It is not known if small amounts of acid used in dialysate to buffer the bicarbonate can meaningfully contribute to overall buffering administered during HD. We aimed to investigate the metabolism of acetate with use of two different acid buffer concentrates and determine if it effects blood bicarbonate concentrations in HD patients. Methods: The Acid-Base Composition with use of hemoDialysates (ABChD) trial was a Phase IV, prospective, single blind, randomized, cross-over, 2 week investigation of peridialytic dynamics of acetate and bicarbonate associated with use of acid buffer concentrates. Eleven prevalent HD patients participated from November 2014 to February 2015. Patients received two HD treatments, with NaturaLyte® and GranuFlo® acid concentrates containing 4 and 8 mEq/L of acetate, respectively. Dialysate order was chosen in a random fashion. The endpoint was to characterize the dynamics of acetate received and metabolized during hemodialysis, and how it effects overall bicarbonate concentrations in the blood and dialysate. Acetate and bicarbonate concentrations were assessed before, at 8 time points during, and 6 time points after the completion of HD. Results: Data from 20 HD treatments for 11 patients (10 NaturaLyte® and 10 GranuFlo®) was analyzed. Cumulative trajectories of arterialized acetate were unique between NaturaLyte® and GranuFlo® (p = 0.003), yet individual time points demonstrated overlap without remarkable differences. Arterialized and venous blood bicarbonate concentrations were similar at HD initiation, but by 240 min into dialysis, mean arterialized bicarbonate concentrations were 30.2 (SD ± 4.16) mEq/L in GranuFlo® and 28.8 (SD ± 4.26) mEq/L in NaturaLyte®. Regardless of acid buffer concentrate, arterial blood bicarbonate was primarily dictated by the prescribed bicarbonate level. Subjects tolerated HD with both acid buffer concentrates without experiencing any related adverse events. Conclusions: A small fraction of acetate was delivered to HD patients with use of NaturaLyte® and GranuFlo® acid buffers; the majority of acetate received was observed to be rapidly metabolized and cleared from the circulation. Blood bicarbonate concentrations appear to be determined mainly by the prescribed concentration of bicarbonate. Trial registration: This trial was registered on ClinicalTrials.gov on 11 Dec 2014 (NCT02334267).

Original languageEnglish (US)
Article number273
JournalBMC Nephrology
Volume18
Issue number1
DOIs
StatePublished - Aug 29 2017

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Hemodialysis Solutions
Base Composition
Bicarbonates
Acetates
Renal Dialysis
Acids
Buffers
Dialysis Solutions

All Science Journal Classification (ASJC) codes

  • Nephrology

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The dynamics of the metabolism of acetate and bicarbonate associated with use of hemodialysates in the ABChD trial : A phase IV, prospective, single center, single blind, randomized, cross-over, two week investigation. / Smith, William; Gibson, Sandy; Newman, George E.; Hendon, Kendra S.; Askelson, Margarita; Zhao, James; Hantash, Jamil; Flanagan, Brigid; Larkin, John W.; Usvyat, Len A.; Thadhani, Ravi I.; Maddux, Franklin W.

In: BMC Nephrology, Vol. 18, No. 1, 273, 29.08.2017.

Research output: Contribution to journalArticle

Smith, William ; Gibson, Sandy ; Newman, George E. ; Hendon, Kendra S. ; Askelson, Margarita ; Zhao, James ; Hantash, Jamil ; Flanagan, Brigid ; Larkin, John W. ; Usvyat, Len A. ; Thadhani, Ravi I. ; Maddux, Franklin W. / The dynamics of the metabolism of acetate and bicarbonate associated with use of hemodialysates in the ABChD trial : A phase IV, prospective, single center, single blind, randomized, cross-over, two week investigation. In: BMC Nephrology. 2017 ; Vol. 18, No. 1.
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abstract = "Background: In the United States, hemodialysis (HD) is generally performed via a bicarbonate dialysate. It is not known if small amounts of acid used in dialysate to buffer the bicarbonate can meaningfully contribute to overall buffering administered during HD. We aimed to investigate the metabolism of acetate with use of two different acid buffer concentrates and determine if it effects blood bicarbonate concentrations in HD patients. Methods: The Acid-Base Composition with use of hemoDialysates (ABChD) trial was a Phase IV, prospective, single blind, randomized, cross-over, 2 week investigation of peridialytic dynamics of acetate and bicarbonate associated with use of acid buffer concentrates. Eleven prevalent HD patients participated from November 2014 to February 2015. Patients received two HD treatments, with NaturaLyte{\circledR} and GranuFlo{\circledR} acid concentrates containing 4 and 8 mEq/L of acetate, respectively. Dialysate order was chosen in a random fashion. The endpoint was to characterize the dynamics of acetate received and metabolized during hemodialysis, and how it effects overall bicarbonate concentrations in the blood and dialysate. Acetate and bicarbonate concentrations were assessed before, at 8 time points during, and 6 time points after the completion of HD. Results: Data from 20 HD treatments for 11 patients (10 NaturaLyte{\circledR} and 10 GranuFlo{\circledR}) was analyzed. Cumulative trajectories of arterialized acetate were unique between NaturaLyte{\circledR} and GranuFlo{\circledR} (p = 0.003), yet individual time points demonstrated overlap without remarkable differences. Arterialized and venous blood bicarbonate concentrations were similar at HD initiation, but by 240 min into dialysis, mean arterialized bicarbonate concentrations were 30.2 (SD ± 4.16) mEq/L in GranuFlo{\circledR} and 28.8 (SD ± 4.26) mEq/L in NaturaLyte{\circledR}. Regardless of acid buffer concentrate, arterial blood bicarbonate was primarily dictated by the prescribed bicarbonate level. Subjects tolerated HD with both acid buffer concentrates without experiencing any related adverse events. Conclusions: A small fraction of acetate was delivered to HD patients with use of NaturaLyte{\circledR} and GranuFlo{\circledR} acid buffers; the majority of acetate received was observed to be rapidly metabolized and cleared from the circulation. Blood bicarbonate concentrations appear to be determined mainly by the prescribed concentration of bicarbonate. Trial registration: This trial was registered on ClinicalTrials.gov on 11 Dec 2014 (NCT02334267).",
author = "William Smith and Sandy Gibson and Newman, {George E.} and Hendon, {Kendra S.} and Margarita Askelson and James Zhao and Jamil Hantash and Brigid Flanagan and Larkin, {John W.} and Usvyat, {Len A.} and Thadhani, {Ravi I.} and Maddux, {Franklin W.}",
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T1 - The dynamics of the metabolism of acetate and bicarbonate associated with use of hemodialysates in the ABChD trial

T2 - A phase IV, prospective, single center, single blind, randomized, cross-over, two week investigation

AU - Smith, William

AU - Gibson, Sandy

AU - Newman, George E.

AU - Hendon, Kendra S.

AU - Askelson, Margarita

AU - Zhao, James

AU - Hantash, Jamil

AU - Flanagan, Brigid

AU - Larkin, John W.

AU - Usvyat, Len A.

AU - Thadhani, Ravi I.

AU - Maddux, Franklin W.

PY - 2017/8/29

Y1 - 2017/8/29

N2 - Background: In the United States, hemodialysis (HD) is generally performed via a bicarbonate dialysate. It is not known if small amounts of acid used in dialysate to buffer the bicarbonate can meaningfully contribute to overall buffering administered during HD. We aimed to investigate the metabolism of acetate with use of two different acid buffer concentrates and determine if it effects blood bicarbonate concentrations in HD patients. Methods: The Acid-Base Composition with use of hemoDialysates (ABChD) trial was a Phase IV, prospective, single blind, randomized, cross-over, 2 week investigation of peridialytic dynamics of acetate and bicarbonate associated with use of acid buffer concentrates. Eleven prevalent HD patients participated from November 2014 to February 2015. Patients received two HD treatments, with NaturaLyte® and GranuFlo® acid concentrates containing 4 and 8 mEq/L of acetate, respectively. Dialysate order was chosen in a random fashion. The endpoint was to characterize the dynamics of acetate received and metabolized during hemodialysis, and how it effects overall bicarbonate concentrations in the blood and dialysate. Acetate and bicarbonate concentrations were assessed before, at 8 time points during, and 6 time points after the completion of HD. Results: Data from 20 HD treatments for 11 patients (10 NaturaLyte® and 10 GranuFlo®) was analyzed. Cumulative trajectories of arterialized acetate were unique between NaturaLyte® and GranuFlo® (p = 0.003), yet individual time points demonstrated overlap without remarkable differences. Arterialized and venous blood bicarbonate concentrations were similar at HD initiation, but by 240 min into dialysis, mean arterialized bicarbonate concentrations were 30.2 (SD ± 4.16) mEq/L in GranuFlo® and 28.8 (SD ± 4.26) mEq/L in NaturaLyte®. Regardless of acid buffer concentrate, arterial blood bicarbonate was primarily dictated by the prescribed bicarbonate level. Subjects tolerated HD with both acid buffer concentrates without experiencing any related adverse events. Conclusions: A small fraction of acetate was delivered to HD patients with use of NaturaLyte® and GranuFlo® acid buffers; the majority of acetate received was observed to be rapidly metabolized and cleared from the circulation. Blood bicarbonate concentrations appear to be determined mainly by the prescribed concentration of bicarbonate. Trial registration: This trial was registered on ClinicalTrials.gov on 11 Dec 2014 (NCT02334267).

AB - Background: In the United States, hemodialysis (HD) is generally performed via a bicarbonate dialysate. It is not known if small amounts of acid used in dialysate to buffer the bicarbonate can meaningfully contribute to overall buffering administered during HD. We aimed to investigate the metabolism of acetate with use of two different acid buffer concentrates and determine if it effects blood bicarbonate concentrations in HD patients. Methods: The Acid-Base Composition with use of hemoDialysates (ABChD) trial was a Phase IV, prospective, single blind, randomized, cross-over, 2 week investigation of peridialytic dynamics of acetate and bicarbonate associated with use of acid buffer concentrates. Eleven prevalent HD patients participated from November 2014 to February 2015. Patients received two HD treatments, with NaturaLyte® and GranuFlo® acid concentrates containing 4 and 8 mEq/L of acetate, respectively. Dialysate order was chosen in a random fashion. The endpoint was to characterize the dynamics of acetate received and metabolized during hemodialysis, and how it effects overall bicarbonate concentrations in the blood and dialysate. Acetate and bicarbonate concentrations were assessed before, at 8 time points during, and 6 time points after the completion of HD. Results: Data from 20 HD treatments for 11 patients (10 NaturaLyte® and 10 GranuFlo®) was analyzed. Cumulative trajectories of arterialized acetate were unique between NaturaLyte® and GranuFlo® (p = 0.003), yet individual time points demonstrated overlap without remarkable differences. Arterialized and venous blood bicarbonate concentrations were similar at HD initiation, but by 240 min into dialysis, mean arterialized bicarbonate concentrations were 30.2 (SD ± 4.16) mEq/L in GranuFlo® and 28.8 (SD ± 4.26) mEq/L in NaturaLyte®. Regardless of acid buffer concentrate, arterial blood bicarbonate was primarily dictated by the prescribed bicarbonate level. Subjects tolerated HD with both acid buffer concentrates without experiencing any related adverse events. Conclusions: A small fraction of acetate was delivered to HD patients with use of NaturaLyte® and GranuFlo® acid buffers; the majority of acetate received was observed to be rapidly metabolized and cleared from the circulation. Blood bicarbonate concentrations appear to be determined mainly by the prescribed concentration of bicarbonate. Trial registration: This trial was registered on ClinicalTrials.gov on 11 Dec 2014 (NCT02334267).

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