Efficacy of the bicarbonate dialysate with acetate concentrations of 0-0.3 and 3-5: A systematic review and meta-analysis.

Abstract

Introduction: Acetic acid in dialysis fluid has been reported to induce symptomatic hypotension and post-dialysis fatigue. However, it remains unclear whether acetate-free dialysate improves these outcomes due to the lack of comprehensive evidence. This systematic review and meta-analysis aimed to compare the effects of acetate-free dialysate with standard acetate-containing dialysate using randomized controlled trials.

Method: We searched databases including MEDLINE, EMBASE, CENTRAL, and trial registries. Primary outcomes were fatigue, intradialytic hypotension (IDH), and all-cause mortality. Secondary outcomes included dropout rate due to adverse events, serum bicarbonate levels, and acid-base 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-analyses, along with the GRADE approach to rate evidence certainty.

Results: 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-free dialysate may slightly reduce IDH (OR 0.83, 95% CI 0.66 to 1.04; I2 = 79%, 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.

Conclusion: In conclusion, no clear benefit was observed for acetate-free dialysate compared with dialysate containing low concentrations of acetate. Further studies are needed to definitively ascertain the benefits of low-acetate dialysates in hemodialysis treatment.