{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T12:24:43Z","timestamp":1753878283075,"version":"3.41.2"},"reference-count":25,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,4,20]],"date-time":"2025-04-20T00:00:00Z","timestamp":1745107200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ther Apher Dial"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Acetic acid in dialysis fluid has been reported to induce symptomatic hypotension and post\u2010dialysis fatigue. However, it remains unclear whether acetate\u2010free dialysate improves these outcomes due to the lack of comprehensive evidence. This systematic review and meta\u2010analysis aimed to compare the effects of acetate\u2010free dialysate with standard acetate\u2010containing dialysate using randomized controlled trials.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>We searched databases including MEDLINE, EMBASE, CENTRAL, and trial registries. Primary outcomes were fatigue, intradialytic hypotension (IDH), and all\u2010cause mortality. Secondary outcomes included dropout rate due to adverse events, serum bicarbonate levels, and acid\u2013base balance (pH) at the study's end. The Cochrane risk of bias tool 2 for crossover trials assessed the risk of bias, and we used a random effects model for meta\u2010analyses, along with the GRADE approach to rate evidence certainty.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We identified four randomized crossover trials involving 114 patients, all at high risk of bias due to period and carryover effects. The studies showed no significant impact on fatigue. Acetate\u2010free dialysate may slightly reduce IDH (OR 0.83, 95% CI 0.66 to 1.04; I2\u2009=\u200979%, across two studies with 5872 sessions) with low certainty of evidence. Results for secondary outcomes, including bicarbonate levels and pH, were inconclusive due to very low certainty of evidence.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In conclusion, no clear benefit was observed for acetate\u2010free dialysate compared with dialysate containing low concentrations of acetate. Further studies are needed to definitively ascertain the benefits of low\u2010acetate dialysates in hemodialysis treatment.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1744-9987.70025","type":"journal-article","created":{"date-parts":[[2025,4,21]],"date-time":"2025-04-21T08:27:46Z","timestamp":1745224066000},"page":"609-619","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Efficacy of the bicarbonate dialysate with acetate concentrations of 0\u20130.3 and 3\u20135: A systematic review and meta\u2010analysis"],"prefix":"10.1111","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0147-5273","authenticated-orcid":false,"given":"Takeshi","family":"Nakata","sequence":"first","affiliation":[{"name":"Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine Oita University  Oita Japan"},{"name":"Scientific Research Works Peer Support Group (SRWS\u2010PSG)  Osaka Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroo","family":"Kawarazaki","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Teikyo University Mizonokuchi Hospital  Kanagawa Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Koshiro","family":"Kanaoka","sequence":"additional","affiliation":[{"name":"Scientific Research Works Peer Support Group (SRWS\u2010PSG)  Osaka Japan"},{"name":"Department of Medical and Health Information Management National Cerebral and Cardiovascular Center  Osaka Japan"},{"name":"Department of Cardiovascular Medicine Nara Medical University  Nara Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miyauchi","family":"Takamasa","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Dialysis Kyoritsu Hospital  Kawanishi Hyogo Japan"},{"name":"Division of Nephrology and Hypertension, Department of Internal Medicine St. Marianna University School of Medicine  Kawasaki Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoshinosuke","family":"Shimamura","sequence":"additional","affiliation":[{"name":"Scientific Research Works Peer Support Group (SRWS\u2010PSG)  Osaka Japan"},{"name":"Department of Medicine Sapporpo Nishimaruyama Hospital  Sapporo Hokkaido Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yasushi","family":"Tsujimoto","sequence":"additional","affiliation":[{"name":"Scientific Research Works Peer Support Group (SRWS\u2010PSG)  Osaka Japan"},{"name":"Oku Medical Clinic  Osaka Japan"},{"name":"Department of Health Promotion and Human Behavior Kyoto University Graduate School of Medicine\/School of Public Health, Kyoto University  Kyoto Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,4,20]]},"reference":[{"doi-asserted-by":"publisher","key":"e_1_2_11_2_1","DOI":"10.1136\/bmjopen-2020-047245"},{"doi-asserted-by":"publisher","key":"e_1_2_11_3_1","DOI":"10.1111\/sdi.12626"},{"doi-asserted-by":"publisher","key":"e_1_2_11_4_1","DOI":"10.1093\/ndt\/18.2.353"},{"doi-asserted-by":"publisher","key":"e_1_2_11_5_1","DOI":"10.1159\/000328004"},{"issue":"3","key":"e_1_2_11_6_1","first-page":"239","article-title":"Identifying dimensions of fatigue in haemodialysis important to patients, caregivers and health professionals: an international survey","volume":"25","author":"Ju A","year":"2020","journal-title":"Nephrol Ther"},{"doi-asserted-by":"publisher","key":"e_1_2_11_7_1","DOI":"10.1038\/ki.2014.86"},{"unstructured":"SONG\u2010HD \u2013 SONG [Internet]. 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