Simplified citrate anticoagulation for high-flux hemodialysis

Area of Science:

• Nephrology
• Critical Care Medicine
• Biochemistry

Background:

• Hemodialysis requires effective anticoagulation to prevent clotting within the extracorporeal circuit.
• Standard anticoagulation often involves low-molecular-weight heparin (dalteparin), which may have bleeding risks.
• Alternative anticoagulation strategies are sought to improve safety and efficacy in hemodialysis.

Purpose of the Study:

• To compare a simple citrate anticoagulation protocol with standard dalteparin anticoagulation in high-flux hemodialysis.
• To evaluate the efficacy in terms of solute removal and homeostasis control.
• To assess safety by measuring bleeding times and markers of hemostasis activation.

Main Methods:

• A randomized crossover trial design was employed.
• Participants underwent high-flux hemodialysis with both citrate and dalteparin anticoagulation.
• Primary end points included urea reduction rate (URR), Kt/V, and electrolyte/acid-base balance.
• Secondary end points involved bleeding time and hemostasis activation markers.

Main Results:

• Citrate and dalteparin demonstrated similar excellent solute removal (URR, Kt/V) and electrolyte homeostasis.
• Alkalemia was significantly less frequent with citrate anticoagulation.
• Bleeding time at vascular puncture sites was reduced by 30% with citrate.
• Platelet, coagulation, and fibrinolysis activation was modest and localized for both methods; no citrate-related adverse events occurred.

Conclusions:

• A simple citrate anticoagulation protocol is feasible and safe for high-flux hemodialysis.
• Citrate offers comparable efficacy to dalteparin with the added benefit of reduced bleeding times.
• This protocol represents a viable alternative to heparin-based anticoagulation in hemodialysis settings.