During intermittent hemodialysis (IHD), the occurrence of intradialytic hemodynamic instability (IHI) is frequent in ICU and impacted morbidity and mortality. Bicarbonate dialysate buffer improves hemodynamic tolerance compared to acetate dialysate buffer. However, bicarbonate dialysate buffer still contains a lower concentration of acetate, which could contribute to hemodynamic instability. Recently, citrate-based dialysate in bicarbonate hemodialysis instead of acetate have been proposed. They have the appropriate authorizations for routine use. The aim of this study is to compare acetate- vs citrate-based dialysate in terms of hemodynamic tolerance and effectiveness.

Inclusion Criteria:

• Patient ≥ 18 years old
• Patient hospitalized in an intensive care unit
• Patient with acute renal failure defined by a KDIGO stage ≥ 1 and suspected non-obstructive
• Patient at risk of per dialytic hypotension (capillary refill time ≥ 3 seconds and/or cardiovascular SOFA ≥ 1 and/or lactatemia > 2mmol/L)
• Indication for Extra Renal Replacement Therapy with IHD.

Exclusion Criteria:

• Pregnant or breastfeeding woman
• Known chronic renal insufficiency of any stage
• Cardio-renal and hepato renal syndrome
• Unstable hemodynamic state: refractory shock
• Patient included in another interventional study likely to modify the hemodynamic state
• Patient deprived of liberty
• Patient under guardianship or curatorship
• Patient not affiliated to a social security system