Article type
Year
Abstract
Introduction/Objective: Comparison of bicarbonate with acetate dialysate in the haemodialysis of patients with ESRD to determine the extra benefits and cost (if any) of bicarbonate dialysis.
Methods: Systematic Literature Review of all possible randomised or quasi-randomised controlled trials comparing bicarbonate with acetate haemodialysis in ESRD. Relevant trials were identified by searching five electronic databases, handsearching of Kidney International 1985 to 1995, contacting relevant authors and biomedical companies and from bibliographies of relevant trials. Trials were assessed for clinical relevance and methodological quality and from those that met our inclusion criteria data were extracted and qualitatively and quantitatively synthesised.
Results: Eighteen studies met our inclusion criteria. Meta-analyses of data from these studies relevant to specific clinical outcomes were performed.
Meta-analysis showing reduction in symptoms during bicarbonate haemodialysis
Adverse symptom during HD No. of treatments* Odds ratio (95% CI) NNT**
Headaches 1563 0.84 (0.71 to 0.99) 33
Nausea/Vomiting 1563 0.42 (0.26 to 0.66) 49
Muscle Cramps 1452 0.97 (0.77 to 1.22) 290
Symptomatic hypertension 198 0.28 (0.11 to 0.69) 17
Non-specific intolerance 1542 0.79 (0.67 to 0.93) 22
* Total number of haemodialysis treatments studied for each symptom.
** NNT - Number Needed to Treat is the average number of haemodialysis treatments with bicarbonate needed to produce one additional treatment without that specific symptom.
Discussion: Bicarbonate dialysis offers some benefit over acetate dialysis in the haemodialysis of patients with ESRD. It presents no significant increased cost and should therefore remain the haemodialysate of choice.
Methods: Systematic Literature Review of all possible randomised or quasi-randomised controlled trials comparing bicarbonate with acetate haemodialysis in ESRD. Relevant trials were identified by searching five electronic databases, handsearching of Kidney International 1985 to 1995, contacting relevant authors and biomedical companies and from bibliographies of relevant trials. Trials were assessed for clinical relevance and methodological quality and from those that met our inclusion criteria data were extracted and qualitatively and quantitatively synthesised.
Results: Eighteen studies met our inclusion criteria. Meta-analyses of data from these studies relevant to specific clinical outcomes were performed.
Meta-analysis showing reduction in symptoms during bicarbonate haemodialysis
Adverse symptom during HD No. of treatments* Odds ratio (95% CI) NNT**
Headaches 1563 0.84 (0.71 to 0.99) 33
Nausea/Vomiting 1563 0.42 (0.26 to 0.66) 49
Muscle Cramps 1452 0.97 (0.77 to 1.22) 290
Symptomatic hypertension 198 0.28 (0.11 to 0.69) 17
Non-specific intolerance 1542 0.79 (0.67 to 0.93) 22
* Total number of haemodialysis treatments studied for each symptom.
** NNT - Number Needed to Treat is the average number of haemodialysis treatments with bicarbonate needed to produce one additional treatment without that specific symptom.
Discussion: Bicarbonate dialysis offers some benefit over acetate dialysis in the haemodialysis of patients with ESRD. It presents no significant increased cost and should therefore remain the haemodialysate of choice.