Abstract: Objective To evaluate the safety, the effects on subsets of lymphocytes (CD4+ and CD8+ cells) and the expression of human leukocyte antigen-DR (HLA-DR) in maintenance hemodialysis patients using citrate and bicarbonate hemodialysate. Methods We used self-control in the study of 30 cases on maintenance hemodialysis. Patients were administrated with acetate and bicarbonate dialysate for 4 weeks as the control group and then with citrate and bicarbonate dialysate for 4 weeks as the treatment group. Blood pressure and heart rate were monitored every hour during hemodialysis. For the observation of serum citrate and ionized calcium changes in the treatment group, blood was taken before dialysis, after dialysis for one hour and at the end of dialysis in the first and the last sessions of dialysis. Changes of circulating CD4+ and CD8+ cells and HLA-DR on blood cells were measured before and after using the dialysate for 4 weeks. Results Blood pressure and heart rate were stable in both groups. In the treatment group, serum citrate remained unchanged, but serum ionized Ca2+ increased significantly after the dialysis. The ratio of CD4+/CD8+ cells in peripheral blood increased in both groups. However, increase of CD4+ cells without change of CD8+ cells was found in the control group, and decrease of CD8+ cells in the absence of CD4+ cell changes was detected in the treatment group. The expression of HLA-DR on blood cells was elevated exclusively in the treatment group. Conclusion Hemodialysate containing citrate and bicarbonate is advantageous for the chronic renal failure patients on maintenance hemodialysis.

Key words: Dialysate, Citric acid, CD4+ and CD8+ lymphocytes