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

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.