Research advances in blood purification solutions_West China Medical Journal

Authors：

ZHAO Yuliang , LIU Caihong , ZHANG Ling ,  FU Ping

Department of Nephrology and Institute of Kidney Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

FU Ping, Email: fupinghx@163.com

Keywords：

Blood purification; replacement fluid; dialysate; catheter lock solution

DOI：

10.7507/1002-0179.202506178

Video：

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Blood purification, as a critical medical intervention for renal function replacement, metabolic waste clearance, and homeostasis maintenance, relies heavily on the optimization of therapeutic solutions to ensure clinical efficacy. In recent years, significant advancements have been made in the formulation design, biocompatibility, and clinical outcomes of blood purification solutions, driven by progress in clinical medicine and biomedical engineering. This article systematically elaborates on the latest research developments in key therapeutic solutions, including continuous renal replacement therapy replacement fluids, hemodialysis dialysate, hemodialysis catheter lock solutions, and peritoneal dialysate. By synthesizing current evidence, the aim is to offer scientific guidance for clinicians in selecting optimal treatment regimens while exploring future directions and emerging trends in the development of blood purification solutions.

Citation： ZHAO Yuliang, LIU Caihong, ZHANG Ling, FU Ping. Research advances in blood purification solutions. West China Medical Journal, 2025, 40(7): 1029-1033. doi: 10.7507/1002-0179.202506178 Copy

1.	赵宇亮, 张凌, 付平. 提高肾脏病整体预后工作组急性肾损伤临床实践指南热点解读. 中华内科杂志, 2012, 51(12): 935-939.
2.	赵宇亮, 张凌, 付平. 枸橼酸抗凝在肾脏替代治疗中的新进展. 中华内科杂志, 2012, 51(7): 571-573.
3.	Zhang L, Liao Y, Xiang J, et al. Simplified regional citrate anticoagulation using a calcium-containing replacement solution for continuous venovenous hemofiltration. J Artif Organs, 2013, 16(2): 185-192.
4.	Rhee H, Berenger B, Mehta RL, et al. Regional citrate anticoagulation for continuous kidney replacement therapy with calcium-containing solutions: a cohort study. Am J Kidney Dis, 2021, 78(4): 550-559.e1.
5.	Wei T, Tang X, Zhang L, et al. Calcium-containing versus calcium-free replacement solution in regional citrate anticoagulation for continuous renal replacement therapy: a randomized controlled trial. Chin Med J (Engl), 2022, 135(20): 2478-2487.
6.	Bellomo R, Cass A, Cole L, et al. The relationship between hypophosphataemia and outcomes during low-intensity and high-intensity continuous renal replacement therapy. Crit Care Resusc, 2014, 16(1): 34-41.
7.	Christopoulou EC, Filippatos TD, Megapanou E, et al. Phosphate imbalance in patients with heart failure. Heart Fail Rev, 2017, 22(3): 349-356.
8.	Oikonomidis IL, Rees P, Hernando Sanz J, et al. Hypophosphatemia in intensive care unit canine patients: occurrence and association with mortality and duration of hospitalization. Vet Clin Pathol, 2025: 2.
9.	Song YH, Seo EH, Yoo YS, et al. Phosphate supplementation for hypophosphatemia during continuous renal replacement therapy in adults. Ren Fail, 2019, 41(1): 72-79.
10.	Thompson Bastin ML, Adams PM, Nerusu S, et al. Association of phosphate containing solutions with incident hypophosphatemia in critically ill patients requiring continuous renal replacement therapy. Blood Purif, 2022, 51(2): 122-129.
11.	Thompson Bastin ML, Stromberg AJ, Nerusu SN, et al. Association of phosphate-containing versus phosphate-free solutions on ventilator days in patients requiring continuous kidney replacement therapy. Clin J Am Soc Nephrol, 2022, 17(5): 634-642.
12.	Abe M, Kalantar-Zadeh K. Haemodialysis-induced hypoglycaemia and glycaemic disarrays. Nat Rev Nephrol, 2015, 11(5): 302-313.
13.	Padmanabhan A, Velayudham B, Vijaykumar N, et al. Evaluation of glycemic status during the days of hemodialysis using dialysis solutions with and without glucose. Saudi J Kidney Dis Transpl, 2018, 29(5): 1021-1027.
14.	Cui L, Meng Y, Xu D, et al. Analysis of the metabolic properties of maintenance hemodialysis patients with glucose-added dialysis based on high performance liquid chromatography quadrupole time-of-flight mass spectrometry. Ther Clin Risk Manag, 2013, 9: 417-425.
15.	Raimann JG, Kruse A, Thijssen S, et al. Fatigue in hemodialysis patients with and without diabetes: results from a randomized controlled trial of two glucose-containing dialysates. Diabetes Care, 2010, 33(9): e121.
16.	蹇丽君, 张凌, 关明镜, 等. 含糖透析液对合并糖尿病的维持性血液透析患者血糖、血压和心率变异性的影响. 西部医学, 2024, 36(5): 776-780.
17.	李莉, 丁嘉祥, 张东亮, 等. 含糖透析液减少维持性血液透析患者低血压发生. 临床和实验医学杂志, 2011, 10(19): 1511-1512.
18.	Rodríguez-Espinosa D, Cuadrado-Payán E, Rico N, et al. Comparative effects of acetate- and citrate-based dialysates on dialysis dose and protein-bound uremic toxins in hemodiafiltration patients: exploring the impact of calcium and magnesium concentrations. Toxins (Basel), 2024, 16(10): 426.
19.	de Sequera P, Pérez-García R, Molina M, et al. Advantages of the use of citrate over acetate as a stabilizer in hemodialysis fluid: a randomized ABC-treat study. Nefrologia (Engl Ed), 2022, 42(3): 327-337.
20.	Akiyama KI, Moriyama T, Hanafusa N, et al. Citric acid-based bicarbonate dialysate attenuates aortic arch calcification in maintenance hemodialysis patients: a retrospective observational study. J Nephrol, 2023, 36(2): 367-376.
21.	Broseta JJ, Roca M, Rodríguez-Espinosa D, et al. Impact of acetate versus citrate dialysates on intermediary metabolism-a targeted metabolomics approach. Int J Mol Sci, 2022, 23(19): 11693.
22.	王越, 李梦婷, 谢庆磊, 等. 不同缓冲剂碳酸氢盐透析液在无肝素血液透析患者中的应用研究. 临床肾脏病杂志, 2023, 23(7): 536-540.
23.	Ureña-Torres P, Bieber B, Guebre-Egziabher F, et al. Citric acid-containing dialysate and survival rate in the dialysis outcomes and practice patterns study. Kidney360, 2021, 2(4): 666-673.
24.	Neri L, Bellocchio F, Kircelli F, et al. Long-term mortality risk associated with citric acid- and acetic acid-based bicarbonate haemodialysis: a historical cohort propensity score-matched study in a large, multicentre, population-based study. Nephrol Dial Transplant, 2020, 35(7): 1237-1244.
25.	Zhao Y, Li Z, Zhang L, et al. Citrate versus heparin lock for hemodialysis catheters: a systematic review and meta-analysis of randomized controlled trials. Am J Kidney Dis, 2014, 63(3): 479-490.
26.	Mai H, Zhao Y, Salerno S, et al. Citrate versus heparin lock for prevention of hemodialysis catheter-related complications: updated systematic review and meta-analysis of randomized controlled trials. Int Urol Nephrol, 2019, 51(6): 1019-1033.
27.	赵宇亮, 杨济桥, 张凌, 等. 枸橼酸和肝素封管液预防血液透析长期留置导管相关感染的 Meta 分析. 中华肾脏病杂志, 2013, 29(8): 574-582.
28.	Jiménez Hernández M, Soriano A, Filella X, et al. Impact of locking solutions on conditioning biofilm formation in tunnelled haemodialysis catheters and inflammatory response activation. J Vasc Access, 2021, 22(3): 370-379.
29.	Nguyen T, Camins BC, Butler DA. Taurolidine and heparin as catheter lock solution for central venous catheters in hemodialysis. Am J Ther, 2024, 31(4): e398-e409.
30.	Agarwal AK, Roy-Chaudhury P, Mounts P, et al. Taurolidine/heparin lock solution and catheter-related bloodstream infection in hemodialysis: a randomized, double-blind, active-control, phase 3 study. Clin J Am Soc Nephrol, 2023, 18(11): 1446-1455.
31.	Wang Y, Sun X. Reevaluation of lock solutions for central venous catheters in hemodialysis: a narrative review. Ren Fail, 2022, 44(1): 1501-1518.
32.	Cho Y, Johnson DW, Craig JC, et al. Biocompatible dialysis fluids for peritoneal dialysis. Cochrane Database Syst Rev, 2014(3): CD007554.
33.	Hashimoto K, Kamijo Y. Current progress in peritoneal dialysis: a narrative review of progress in peritoneal dialysis fluid. Life (Basel), 2025, 15(2): 279.
34.	Tjiong HL, Swart R, van den Berg JW, et al. Amino acid-based peritoneal dialysis solutions for malnutrition: new perspectives. Perit Dial Int, 2009, 29(4): 384-393.
35.	Asola M, Virtanen K, Någren K, et al. Amino-acid-based peritoneal dialysis solution improves amino-acid transport into skeletal muscle. Kidney Int Suppl, 2008(108): S131-S136.
36.	Bender TO, Witowski J, Aufricht C, et al. Biocompatibility of a bicarbonate-buffered amino-acid-based solution for peritoneal dialysis. Pediatr Nephrol, 2008, 23(9): 1537-1543.
37.	Chang JM, Chen HC, Hwang SJ, et al. Does amino acid-based peritoneal dialysate change homocysteine metabolism in continuous ambulatory peritoneal dialysis patients?. Perit Dial Int, 2003, 23(Suppl 2): S48-S51.
38.	Iyasere O, Nagar R, Jesus-Silva JA, et al. The impact of amino acid dialysate on anthropometric measures in adult patients on peritoneal dialysis: a systematic review and meta-analysis. Perit Dial Int, 2022, 42(3): 314-323.

1. 赵宇亮, 张凌, 付平. 提高肾脏病整体预后工作组急性肾损伤临床实践指南热点解读. 中华内科杂志, 2012, 51(12): 935-939.
2. 赵宇亮, 张凌, 付平. 枸橼酸抗凝在肾脏替代治疗中的新进展. 中华内科杂志, 2012, 51(7): 571-573.
3. Zhang L, Liao Y, Xiang J, et al. Simplified regional citrate anticoagulation using a calcium-containing replacement solution for continuous venovenous hemofiltration. J Artif Organs, 2013, 16(2): 185-192.
4. Rhee H, Berenger B, Mehta RL, et al. Regional citrate anticoagulation for continuous kidney replacement therapy with calcium-containing solutions: a cohort study. Am J Kidney Dis, 2021, 78(4): 550-559.e1.
5. Wei T, Tang X, Zhang L, et al. Calcium-containing versus calcium-free replacement solution in regional citrate anticoagulation for continuous renal replacement therapy: a randomized controlled trial. Chin Med J (Engl), 2022, 135(20): 2478-2487.
6. Bellomo R, Cass A, Cole L, et al. The relationship between hypophosphataemia and outcomes during low-intensity and high-intensity continuous renal replacement therapy. Crit Care Resusc, 2014, 16(1): 34-41.
7. Christopoulou EC, Filippatos TD, Megapanou E, et al. Phosphate imbalance in patients with heart failure. Heart Fail Rev, 2017, 22(3): 349-356.
8. Oikonomidis IL, Rees P, Hernando Sanz J, et al. Hypophosphatemia in intensive care unit canine patients: occurrence and association with mortality and duration of hospitalization. Vet Clin Pathol, 2025: 2.
9. Song YH, Seo EH, Yoo YS, et al. Phosphate supplementation for hypophosphatemia during continuous renal replacement therapy in adults. Ren Fail, 2019, 41(1): 72-79.
10. Thompson Bastin ML, Adams PM, Nerusu S, et al. Association of phosphate containing solutions with incident hypophosphatemia in critically ill patients requiring continuous renal replacement therapy. Blood Purif, 2022, 51(2): 122-129.
11. Thompson Bastin ML, Stromberg AJ, Nerusu SN, et al. Association of phosphate-containing versus phosphate-free solutions on ventilator days in patients requiring continuous kidney replacement therapy. Clin J Am Soc Nephrol, 2022, 17(5): 634-642.
12. Abe M, Kalantar-Zadeh K. Haemodialysis-induced hypoglycaemia and glycaemic disarrays. Nat Rev Nephrol, 2015, 11(5): 302-313.
13. Padmanabhan A, Velayudham B, Vijaykumar N, et al. Evaluation of glycemic status during the days of hemodialysis using dialysis solutions with and without glucose. Saudi J Kidney Dis Transpl, 2018, 29(5): 1021-1027.
14. Cui L, Meng Y, Xu D, et al. Analysis of the metabolic properties of maintenance hemodialysis patients with glucose-added dialysis based on high performance liquid chromatography quadrupole time-of-flight mass spectrometry. Ther Clin Risk Manag, 2013, 9: 417-425.
15. Raimann JG, Kruse A, Thijssen S, et al. Fatigue in hemodialysis patients with and without diabetes: results from a randomized controlled trial of two glucose-containing dialysates. Diabetes Care, 2010, 33(9): e121.
16. 蹇丽君, 张凌, 关明镜, 等. 含糖透析液对合并糖尿病的维持性血液透析患者血糖、血压和心率变异性的影响. 西部医学, 2024, 36(5): 776-780.
17. 李莉, 丁嘉祥, 张东亮, 等. 含糖透析液减少维持性血液透析患者低血压发生. 临床和实验医学杂志, 2011, 10(19): 1511-1512.
18. Rodríguez-Espinosa D, Cuadrado-Payán E, Rico N, et al. Comparative effects of acetate- and citrate-based dialysates on dialysis dose and protein-bound uremic toxins in hemodiafiltration patients: exploring the impact of calcium and magnesium concentrations. Toxins (Basel), 2024, 16(10): 426.
19. de Sequera P, Pérez-García R, Molina M, et al. Advantages of the use of citrate over acetate as a stabilizer in hemodialysis fluid: a randomized ABC-treat study. Nefrologia (Engl Ed), 2022, 42(3): 327-337.
20. Akiyama KI, Moriyama T, Hanafusa N, et al. Citric acid-based bicarbonate dialysate attenuates aortic arch calcification in maintenance hemodialysis patients: a retrospective observational study. J Nephrol, 2023, 36(2): 367-376.
21. Broseta JJ, Roca M, Rodríguez-Espinosa D, et al. Impact of acetate versus citrate dialysates on intermediary metabolism-a targeted metabolomics approach. Int J Mol Sci, 2022, 23(19): 11693.
22. 王越, 李梦婷, 谢庆磊, 等. 不同缓冲剂碳酸氢盐透析液在无肝素血液透析患者中的应用研究. 临床肾脏病杂志, 2023, 23(7): 536-540.
23. Ureña-Torres P, Bieber B, Guebre-Egziabher F, et al. Citric acid-containing dialysate and survival rate in the dialysis outcomes and practice patterns study. Kidney360, 2021, 2(4): 666-673.
24. Neri L, Bellocchio F, Kircelli F, et al. Long-term mortality risk associated with citric acid- and acetic acid-based bicarbonate haemodialysis: a historical cohort propensity score-matched study in a large, multicentre, population-based study. Nephrol Dial Transplant, 2020, 35(7): 1237-1244.
25. Zhao Y, Li Z, Zhang L, et al. Citrate versus heparin lock for hemodialysis catheters: a systematic review and meta-analysis of randomized controlled trials. Am J Kidney Dis, 2014, 63(3): 479-490.
26. Mai H, Zhao Y, Salerno S, et al. Citrate versus heparin lock for prevention of hemodialysis catheter-related complications: updated systematic review and meta-analysis of randomized controlled trials. Int Urol Nephrol, 2019, 51(6): 1019-1033.
27. 赵宇亮, 杨济桥, 张凌, 等. 枸橼酸和肝素封管液预防血液透析长期留置导管相关感染的 Meta 分析. 中华肾脏病杂志, 2013, 29(8): 574-582.
28. Jiménez Hernández M, Soriano A, Filella X, et al. Impact of locking solutions on conditioning biofilm formation in tunnelled haemodialysis catheters and inflammatory response activation. J Vasc Access, 2021, 22(3): 370-379.
29. Nguyen T, Camins BC, Butler DA. Taurolidine and heparin as catheter lock solution for central venous catheters in hemodialysis. Am J Ther, 2024, 31(4): e398-e409.
30. Agarwal AK, Roy-Chaudhury P, Mounts P, et al. Taurolidine/heparin lock solution and catheter-related bloodstream infection in hemodialysis: a randomized, double-blind, active-control, phase 3 study. Clin J Am Soc Nephrol, 2023, 18(11): 1446-1455.
31. Wang Y, Sun X. Reevaluation of lock solutions for central venous catheters in hemodialysis: a narrative review. Ren Fail, 2022, 44(1): 1501-1518.
32. Cho Y, Johnson DW, Craig JC, et al. Biocompatible dialysis fluids for peritoneal dialysis. Cochrane Database Syst Rev, 2014(3): CD007554.
33. Hashimoto K, Kamijo Y. Current progress in peritoneal dialysis: a narrative review of progress in peritoneal dialysis fluid. Life (Basel), 2025, 15(2): 279.
34. Tjiong HL, Swart R, van den Berg JW, et al. Amino acid-based peritoneal dialysis solutions for malnutrition: new perspectives. Perit Dial Int, 2009, 29(4): 384-393.
35. Asola M, Virtanen K, Någren K, et al. Amino-acid-based peritoneal dialysis solution improves amino-acid transport into skeletal muscle. Kidney Int Suppl, 2008(108): S131-S136.
36. Bender TO, Witowski J, Aufricht C, et al. Biocompatibility of a bicarbonate-buffered amino-acid-based solution for peritoneal dialysis. Pediatr Nephrol, 2008, 23(9): 1537-1543.
37. Chang JM, Chen HC, Hwang SJ, et al. Does amino acid-based peritoneal dialysate change homocysteine metabolism in continuous ambulatory peritoneal dialysis patients?. Perit Dial Int, 2003, 23(Suppl 2): S48-S51.
38. Iyasere O, Nagar R, Jesus-Silva JA, et al. The impact of amino acid dialysate on anthropometric measures in adult patients on peritoneal dialysis: a systematic review and meta-analysis. Perit Dial Int, 2022, 42(3): 314-323.

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