Acetate-Free Dialysate Shows No Nutritional or Muscle Benefits in Hemodialysis Patients: Study

A new study published in the Clinical Kidney Journal showed that the utilization of dialysate without acetate did not lead to enhancements in nutritional status or muscle function when compared to traditional low-acetate dialysate in individuals receiving regular hemodialysis treatment.

Protein-energy wasting and muscle atrophy are prevalent among individuals undergoing maintenance hemodialysis and are associated with negative consequences. The presence of acetate in dialysate concentrate derived from acetic acid may contribute to inflammation and disruptions in metabolism. This study aimed to assess the potential benefits of utilizing acetate-free dialysate produced from a concentrate containing hydrochloric acid in enhancing the nutritional status and outcomes related to muscle health in patients undergoing chronic hemodialysis.

During this study conducted at one medical center, individuals undergoing regular hemodialysis were randomly assigned to either acetate-free or acetate-containing dialysate for a period of 6 months. After this initial phase, they switched to the opposite type of dialysate for another 6 months. The main focus was on serum prealbumin levels. Additional factors examined included body composition using bioimpedance spectroscopy, handgrip strength, walking speed over 4 meters, SARC-F score, serum albumin levels, and C-reactive protein levels. The data was assessed using statistical models that accounted for the order of treatment and the time period, with each patient considered as a random factor.

60 individuals were part of the study, where the average age was 68.8 ± 9.4 years, and 72.4% were men. The levels of prealbumin stayed consistent when using dialysate with acetate, starting at 0.291 ± 0.079 g/l at the beginning and ending at 0.287 ± 0.076 g/l by the sixth month.

With acetate-free dialysate, the levels changed from 0.294 ± 0.085 to 0.279 ± 0.074 g/l. There was no significant impact of dialysate type on prealbumin levels over time (P = .386). Other factors such as lean tissue index, fat tissue index, handgrip strength, 4-m gait speed, serum albumin, and C-reactive protein showed no notable changes. In terms of safety, no notable differences were observed in infection rates, cardiovascular incidents, and mortality between the different approaches.

Overall, the absence of acetate in the dialysate did not show any improvement in protein-energy wasting indicators, muscle mass, or inflammation markers compared to the conventional dialysate containing acetate. Both types of dialysate were well accepted and had comparable safety records.

Reference:

Aniort, J., Grall, S., Batel, V., Pereira, B., & Heng, A.-E. (2026). Acetate-free dialysate, protein-energy wasting, and muscle outcomes in maintenance hemodialysis: a randomized-controlled trial. Clinical Kidney Journal, 19(10), sfag323. https://doi.org/10.1093/ckj/sfag323