Fundamental study of a bicarbonate dialysate acidified with citric acid

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  • クエン酸含有重炭酸透析液の基礎的研究
  • クエンサン ガンユウジュウ タンサン トウセキエキ ノ キソテキ ケンキュウ

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The characteristics of a newly developed bicarbonate dialysate acidified with citric acid were studied. Carbostar ® L (CL) (Ajinomoto Pharma, Tokyo) was compared with conventional bicarbonate dialysates acidified with acetic acid:Kindary® AF2 (K2), AF3 (K3) (Fuso Pharma, Osaka). After dilution of CL, K2 and K3 at the regular mixing ratio, changes in the concentrations of total calcium (tCa) and ionized Ca (iCa), and also of the pH and pCO2, were measured under a sealed condition after 0, 2, 4, 19, 24 and 48 hours. The size and number of Ca precipitates were measured simultaneously under a polarizing microscope. SUS316 steel and fluoro rubber were immersed in concentrate A solutions of CL and K2 for 4 months, then the Fe, Cr, Ni and Mn levels eluted into the solution were measured, along with tensile strength testing and surface scanning of fluoro rubber under an electron microscope. The levels of glucose degradation products (3-deoxyglucoson ; 3-DG, 5-hydroxymethylflufural ; 5-HMF and levulinic acid) were measured in CL, K3 following 6 months storage under high-temperature conditions (40℃ and 50℃). The tCa level was significantly higher in K3 than in CL or K2, and the iCa level was significantly lower in CL than in K2 or K3. There were significant differences in the ratio of iCa/tCa among CL (0.64±0.09), K2 (0.84±0.05) and K3 (0.91±0.06). The size of Ca precipitates was larger in CL than in K2 and K3, but there were no differences in the number of precipitates among CL, K2 and K3. There were no significant differences in the level of eluting metals, the tensile strength or surface scanning findings of fluoro rubber among CL, K2 and K3. The level of 3-DG was significantly higher in K3 than in CL. The level of 5-HMF was significantly higher in CL than in K3, suggesting accelerated degradation of glucose in CL. In conclusion, there may not be any problem of deterioration of machine materials associated with the clinical use of citrate dialysate. However, careful observation to detect a low iCa level and accelerated degradation of glucose may be necessary.

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