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Related Experiment Videos

Citrate anticoagulation and adverse events.

J De Vos1, R Hombrouckx

  • 1AZ Werken Glorieux, Hogerlucht 6, 9600 Ronse, Belgium. devosjy@skynet.be

EDTNA/ERCA Journal (English Ed.)
|October 14, 2003
PubMed
Summary

Tri-sodium citrate used as an anticoagulant during dialysis for heparin-intolerant patients initially showed good tolerance. However, prolonged use led to metabolic alkalosis, hypernatremia, and significant aluminum toxicity due to leaching from glass containers.

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Area of Science:

  • Nephrology
  • Biochemistry

Background:

  • Heparin intolerance necessitates alternative anticoagulants for hemodialysis.
  • Tri-sodium citrate is a potential alternative anticoagulant for hemodialysis.

Purpose of the Study:

  • To evaluate the long-term safety and efficacy of tri-sodium citrate as an anticoagulant in hemodialysis patients.
  • To identify and address adverse events associated with tri-sodium citrate use.

Main Methods:

  • Hemodialysis patients with heparin intolerance were treated with tri-sodium citrate.
  • Biochemical parameters (bicarbonate, sodium, aluminum) and clinical tolerance were monitored.
  • Dialysis fluid composition and anticoagulant storage containers were adjusted to manage adverse effects.

Main Results:

  • Patients developed metabolic alkalosis and hypernatremia, responsive to adjustments in dialysis fluid composition.
  • A significant increase in serum aluminum levels was observed, linked to leaching from glass storage bottles.
  • Switching to polyvinyl chloride bags resolved aluminum toxicity.

Conclusions:

  • While tri-sodium citrate offers an alternative for heparin-intolerant patients, careful monitoring for metabolic disturbances is crucial.
  • Aluminum contamination from glass containers is a significant risk associated with tri-sodium citrate, requiring appropriate storage solutions.

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