{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T18:21:26Z","timestamp":1790878886640,"version":"4.1.0"},"reference-count":42,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Kidney360"],"published-print":{"date-parts":[[2021,4]]},"abstract":"\n Key Points<\/jats:title>\n \n \n \n Citric acid\u2013containing dialysate for hemodialysis was prescribed to 20%\u201325% of patients in Japanese, Italian, and Belgium centers in the Dialysis Outcomes and Practice Patterns Study.<\/jats:p>\n <\/jats:list-item>\n \n The use of citric acid\u2013containing bicarbonate-based dialysate was not associated with mortality in the international Dialysis Outcomes and Practice Patterns Study cohort.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>\n \n Background<\/jats:title>\n Metabolic acidosis is a common threat for patients on hemodialysis, managed by alkaline dialysate. The main base is bicarbonate, to which small amounts of acetic, citric, or hydrochloric acid are added. The first two are metabolized to bicarbonate, mostly by the liver. Citric acid\u2013containing dialysate might improve dialysis efficiency, anticoagulation, calcification propensity score, and intradialytic hemodynamic stability. However, a recent report from the French dialysis registry suggested this dialysate increases mortality risk. This prompted us to assess whether citric acid\u2013containing bicarbonate-based dialysate was associated with mortality in the international Dialysis Outcomes and Practice Patterns Study (DOPPS).<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Detailed patient-based information on dialysate composition was collected in DOPPS phases 5 and 6 (2012\u20132017). Cox regression was used to model the association between baseline bicarbonate dialysate containing citric acid versus not containing citric acid and mortality among DOPPS countries and phases where citric acid\u2013containing dialysate was used.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Citric acid-containing dialysate was most commonly used in Japan, Italy, and Belgium (25%, 25%, 21% and of patients who were DOPPS phase 6, respectively) and used in <10% of patients in other countries. Among 11,306 patients in DOPPS country and phases with at least 15 patients using citric acid-containing dialysate, patient demographics, comorbidities, and laboratories were similar among patients using (14%) versus not using (86%) citric acid-containing dialysate. After accounting for case mix, we did not observe a directional association between citric acid\u2013containing dialysate use (any versus none) and mortality (HR, 1.14; 95% CI, 0.97 to 1.34), nor did we find evidence of a dose-dependent relationship when parameterizing the citric acid concentration in the dialysate as 1, 2, and 3+ mEq\/L.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The use of citric acid\u2013containing dialysate was not associated with greater risk of all-cause mortality in patients on hemodialysis participating in DOPPS. Clinical indications for the use of citric acid\u2013containing dialysate deserve further investigation.<\/jats:p>\n <\/jats:sec>","DOI":"10.34067\/kid.0006182020","type":"journal-article","created":{"date-parts":[[2021,2,4]],"date-time":"2021-02-04T18:23:11Z","timestamp":1612462991000},"page":"666-673","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":9,"title":["Citric Acid\u2013Containing Dialysate and Survival Rate in the Dialysis Outcomes and Practice Patterns Study"],"prefix":"10.34067","volume":"2","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6757-1906","authenticated-orcid":false,"given":"Pablo","family":"Ure\u00f1a-Torres","sequence":"first","affiliation":[{"name":"Department of Dialysis, Association pour l'Utilisation du Rein Artificiel en Ile de France, Nord Saint Ouen, Saint Ouen, France"},{"name":"Department of Renal Physiology, Necker Hospital, University of Paris Descartes, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Bieber","sequence":"additional","affiliation":[{"name":"Dialysis Outcomes and Practice Patterns Study (DOPPS) Coordinating Center, Arbor Research Collaborative for Health, Ann Arbor, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fitsum","family":"Guebre-Egziabher","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Hypertension and Dialysis, Hospices Civils de Lyon, H\u00f4pital Edouard Herriot, Lyon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rim","family":"Ossman","sequence":"additional","affiliation":[{"name":"Department of Dialysis, Association pour l'Utilisation du Rein Artificiel en Ile de France, Nord Saint Ouen, Saint Ouen, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michel","family":"Jadoul","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Dialysis. Universitary Clinics Saint Luc, Catholic University of Louvain, Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masaaki","family":"Inaba","sequence":"additional","affiliation":[{"name":"Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruce M.","family":"Robinson","sequence":"additional","affiliation":[{"name":"Dialysis Outcomes and Practice Patterns Study (DOPPS) Coordinating Center, Arbor Research Collaborative for Health, Ann Arbor, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Friedrich","family":"Port","sequence":"additional","affiliation":[{"name":"Dialysis Outcomes and Practice Patterns Study (DOPPS) Coordinating Center, Arbor Research Collaborative for Health, Ann Arbor, 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