Acetate-free dialysate, protein-energy wasting, and muscle outcomes in maintenance hemodialysis: a randomized-controlled trial
In brief
Acetate-free dialysate does not improve nutrition or muscle measures in hemodialysis
In a 60-person randomized crossover trial, six months of acetate-free dialysate did not improve prealbumin, body composition, grip strength, walking speed, albumin, or inflammation compared with conventional dialysate. Safety outcomes also did not differ significantly. The single-center trial found no advantage on these measures, leaving larger studies to assess whether specific patient groups benefit.
- Journal
- Clinical kidney journal (Q1)
- Published
- 22 September 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Julien Aniort, Solene Grall, Valerie Batel, Bruno Pereira, Anne-Elisabeth Heng
- PMID
- 42840626
- DOI
- 10.1093/ckj/sfag323
Why clinicians should know about it
- Picked for Nephrology (top studies of the week, 1 November 2026): Randomized crossover trial of dialysate composition in HD
Abstract
BACKGROUND: Protein-energy wasting and muscle atrophy are common in maintenance hemodialysis and linked to adverse outcomes. Acetate from acetic acid-containing dialysate concentrate may promote inflammation and metabolic disturbances. We evaluated whether acetate-free dialysate prepared from a hydrochloric acid-containing concentrate could improve nutritional status and muscle-related outcomes in chronic hemodialysis patients. METHODS: In this single-center, single-blind, randomized crossover trial, adults receiving maintenance hemodialysis were assigned to acetate-free or acetate-containing dialysate for 6 months, followed by crossover to the alternate dialysate for an additional 6 months. The primary endpoint was serum prealbumin. Secondary endpoints included body composition assessed by bioimpedance spectroscopy, handgrip strength, 4-m gait speed, SARC-F score, serum albumin, and C-reactive protein. Outcomes were analyzed using linear mixed-effects models adjusted for period and treatment sequence, with patient included as a random effect. RESULTS: Sixty patients were included. The mean age was 68.8 ± 9.4 years, and 72.4% were male. Prealbumin concentrations remained stable with acetate-containing dialysate, from 0.291 ± 0.079 g/l at baseline to 0.287 ± 0.076 g/l at month 6, and with acetate-free dialysate, from 0.294 ± 0.085 to 0.279 ± 0.074 g/l. The dialysate-by-time interaction was not significant (P = .386). Lean tissue index, fat tissue index, handgrip strength, 4-m gait speed, serum albumin, and C-reactive protein remained unchanged. Safety outcomes, including infectious and cardiovascular events and mortality, did not differ significantly between strategies. CONCLUSION: In this randomized crossover trial, acetate-free dialysate did not improve nutritional and muscle status compared with conventional acetate-containing dialysate.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.