Version May 2024
The dialysate solution used for an intermittent hemodialysis session is uniquely created for each patient and ultimately based on mixing 3 components: acid concentrate, sodium bicarbonate concentrate (ie, the base), and purified water. In the US, water used in dialysate should meet or exceed standards set forth by the International Organization for Standardization (ISO), and subsequently adopted by the American National Standards Institute (ANSI) in collaboration with the Association for the Advancement of Medical Instrumentation (AAMI).
Acid concentrate and sodium bicarbonate concentrate products should be mixed only in the dilution (ie, proportioning ratio) specified (eg, 35X, 36.83X, 45X) and used only in the type of hemodialysis machine/system specifically recommended by the manufacturer. In addition, some acid concentrate products and sodium bicarbonate concentrate products should only be used in conjunction with those specifically recommended as compatible by the manufacturer. Consult specific manufacturer’s product information for all compatibility recommendations.
Acid Concentrate:
Liquid:
Centrisol-Part A: Sodium 137 mEq/L, Potassium 0 to 4 mEq/L, Calcium 0 to 3 mEq/L, Magnesium 0.75 mEq/L, Chloride 100.75 to 107.75 mEq/L, Acetate 4 to 5 mEq/L, Dextrose 100 to 200 mg/dL, Bicarbonate 32 to 33 mEq/L [strength represents amount after recommended dilution; formulations available for use with proportioning ratio: 45X]
Centrisol 100 Dextrose-Part A: Sodium 137 mEq/L, Potassium 0 to 3 mEq/L, Calcium 0 to 2.5 mEq/L, Magnesium 0.75 mEq/L, Chloride 100.75 to 106 mEq/L, Acetate 4 to 5 mEq/L, Dextrose 100 mg/dL, Bicarbonate 32 to 33 mEq/L [strength represents amount after recommended dilution; formulations available for use with proportioning ratio: 45X]
CitraPure: Sodium 137 mEq/L, Potassium 1 to 3 mEq/L, Calcium 2 to 3 mEq/L, Magnesium 1 mEq/L, Citric acid 2.4 mEq/L, Dextrose 100 mg/dL [strength represents amount after recommended dilution; formulations available for use with proportioning ratio: 45X]
Citrasate: Sodium 100.3 mEq/L, Potassium 1 to 3 mEq/L, Calcium 2.5 mEq/L, Magnesium 1 mEq/L, Chloride 104.50 to 106.5 mEq/L, Acetate 0.3 mEq/L, Dextrose 100 mg/dL, Citrate 2.4 mEq/L [strength represents amount after recommended dilution; formulations available for use with proportioning ratio: 45X]
CitriSol: Sodium 80 to 100 mEq/L, Potassium 0 to 4 mEq/L, Calcium 0 to 2.5 mEq/L, Magnesium 1 mEq/L, Dextrose 100 mg/dL [strength represents amount after recommended dilution; formulations available for use with proportioning ratio: 35X, 36.83X, and 45X]
Diasol: Sodium 80 to 100 mEq/L, Potassium 0 to 4 mEq/L, Calcium 0 to 3.5 mEq/L, Magnesium 0.70 to 1 mEq/L, Dextrose 100 to 200 mg/dL [strength represents amount after recommended dilution; formulations available for use with proportioning ratio: 35X, 36.83X, and 45X]
NaturaLyte: Sodium 100 mEq/L, Potassium 0 to 4 mEq/L, Calcium 0 to 3.5 mEq/L, Magnesium 1 mEq/L, Chloride 102 to 107.25 mEq/L, Acetate 4 mEq/L, Dextrose 100 mg/dL [strength represents amount after recommended dilution; formulations available for use with proportioning ratio: 45X]
NaturaLyte-4000 Series: Sodium 100 mEq/L, Potassium 0 to 4 mEq/L, Calcium 0 to 3.5 mEq/L, Magnesium 1 mEq/L, Chloride 102 to 107.25 mEq/L, Acetate 4 mEq/L, Dextrose 100 mg/dL [strength represents amount after recommended dilution; formulations available for use with proportioning ratio: 45X]
RenalPure: Sodium 137 mEq/L, Potassium 0 to 3 mEq/L, Calcium 0 to 3 mEq/L, Magnesium 0.75 mEq/L, Chloride 104 to 106 mEq/L, Acetic acid 4 mEq/L, Dextrose 100 mg/dL [strength represents amount after recommended dilution; formulations available for use with proportioning ratio: 45X]
Renasol-Part A: Sodium 139 to 143 mEq/L, Potassium 0 to 3 mEq/L, Calcium 0 to 3.5 mEq/L, Magnesium 0.75 to 1.5 mEq/L, Chloride 101 to 110.25 mEq/L, Acetate 4 to 4.5 mEq/L, Dextrose 200 to 250 mg/dL, Bicarbonate 34.5 to 35 mEq/L [strength represents amount after recommended dilution; formulations available for use with proportioning ratio: 36.83X]
Renasol 100 Dextrose – Part A: Sodium 140 mEq/L, Potassium 2 mEq/L, Calcium 2.5 mEq/L, Magnesium 0.5 mEq/L, Chloride 106 mEq/L, Acetate 4 mEq/L, Dextrose 100 mg/dL, Bicarbonate 35 mEq/L [strength represents amount after recommended dilution; formulations available for use with proportioning ratio: 36.83X]
Powder:
Citrasate Dry: Sodium 100.3 mEq/L, Potassium 1 to 3 mEq/L, Calcium 2.25 to 3 mEq/L, Magnesium 1 mEq/L, Chloride 104.25 to 107 mEq/L, Acetate 0.3 mEq/L, Dextrose 100 mg/dL, Citrate 2.4 mEq/L [strength represents amount after recommended dilution; formulations available for use with proportioning ratio: 45X]
CitriSol: Sodium 80 to 100 mEq/L, Potassium 0 to 4 mEq/L, Calcium 0 to 2.5 mEq/L, Magnesium 1 mEq/L, Dextrose 100 mg/dL [strength represents amount after recommended dilution; formulations available for use with proportioning ratio: 35X, 36.83X, and 45X]
Dri-Sate: Sodium 137 mEq/L, Potassium 2 mEq/L, Calcium 2 to 2.5 mEq/L, Magnesium 0.75 mEq/L, Chloride 105 to 106 mEq/L, Acetic acid 4 mEq/L, Dextrose 100 mg/dL [strength represents amount after recommended dilution; formulations available for use with proportioning ratio: 45X]
Dryasol: Sodium 80 to 100 mEq/L, Potassium 0 to 4 mEq/L, Calcium 0 to 3.5 mEq/L, Magnesium 0.70 to 1 mEq/L, Dextrose 100 to 200 mg/dL [strength represents amount after recommended dilution; formulations available for use with proportioning ratio: 35X, 36.83X, and 45X]
GranuFlo – 2400 Series: Sodium 100 mEq/L, Potassium 1 to 3 mEq/L, Calcium 2 to 3 mEq/L, Magnesium 1 mEq/L, Chloride 100.5 to 103 mEq/L, Acetate 8 mEq/L, Dextrose 100 mg/dL [strength represents amount after recommended dilution; formulations available for use with proportioning ratio: 45X]
Bicarbonate Concentrate:
Liquid:
Centrisol-Part B: [formulations available for use with proportioning ratio: 45X]
Renasol-Part B: [formulations available for use with proportioning ratio: 36.83X]
SteriLyte: Sodium 37 mEq/L, Bicarbonate 37 mEq/L [strength represents final dialysate electrolyte yield; formulations available for use with proportioning ratio: 45X]
Powder:
Bibag: (650 g, 900 g) [formulations available for use with proportioning ratio: 45X]
Centrisol-Part B: [formulations available for use with proportioning ratio: 45X]
NaturaLyte-4000 Series: Sodium 37 mEq/L, Bicarbonate 37 mEq/L [strength represents final dialysate electrolyte yield; formulations available for use with proportioning ratio: 45X]
RenalPure: Sodium 37 mEq/L, Bicarbonate 37 mEq/L [strength represents final dialysate electrolyte yield; formulations available for use with proportioning ratio: 45X]
Renasol-Part B: [formulations available for use with proportioning ratio: 36.83X]
Powder Cartridge:
Solcart B: (650 g, 760 g, 1100 g)
BiCart: (720 g, 1250 g) [formulations available for use with proportioning ratio: 35 X, 45X]
For use in a dialyzer during conventional, intermittent hemodialysis sessions to remove toxins and extra fluid from the body, and help regulate electrolytes and acid-base balance in patients in severe kidney failure or with end-stage kidney disease.
The Institute for Safe Medication Practices (ISMP) includes hemodialysis solutions among its list of drugs which have a heightened risk of causing significant patient harm when used in error.
Acid concentrate dialysate products may contain acetate, citrate, and/or acetic acid which can be converted in the body to bicarbonate. Dosing errors have occurred when practitioners have failed to consider the contribution of these substances to the patient’s overall bicarbonate levels. This oversight may lead to metabolic alkalosis in hemodialysis patients, which is a significant risk factor associated with cardiopulmonary arrest, hypotension, hypokalemia, hypoxemia, hypercapnia, and cardiac arrhythmia.
The presence and quantity of acetate, citrate, and/or acetic acid vary by formulation and manufacturer; specific product labeling should be reviewed. Practitioners should always be aware that preexisting metabolic alkalosis (pre-dialysis serum bicarbonate levels ≥27 mEq/L) have been associated with an increased risk of mortality in hemodialysis patients.
None known.
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