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The bicarbonate-based dialysate contains a few millimoles of acetic acid to stabilize the pH. Due to the favourable dialysate–plasma gradient, the plasma acetate levels at the end of the haemodialysis (HD) session are several times higher than pre-treatment, such as to induce the well-known acetate adverse effects.[1] Citric acid is an alternative dialysate buffer that is converted to its anion citrate into the body.
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