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Anticoagulation during haemodialysis using a citrate-enriched dialysate: a feasibility study
Yuk-Lun Cheng1, Alex W Yu, Kwong-Yuen Tsang
1Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Chinese University of Hong Kong, Hong Kong, China. chengyl1@ha.org.hk
Summary
A simple citrate-enriched dialysate effectively anticoagulated the extracorporeal circuit during haemodialysis. This method proved simpler and safer than conventional saline flushing for high-risk patients.
Area of Science:
- Nephrology
- Cardiovascular System
- Biochemistry
Background:
- Haemodialysis requires anticoagulation to prevent extracorporeal circuit clotting.
- Patients at high risk for bleeding often pose challenges for standard anticoagulation methods.
Purpose of the Study:
- To evaluate the feasibility and safety of using a citrate-enriched dialysate for anticoagulation during haemodialysis.
- To compare citrate-enriched dialysate anticoagulation with conventional saline flushing in high-risk patients.
Main Methods:
- A prospective, randomized, cross-over study involving 24 high-risk patients.
- Citrate-enriched dialysate (3 mEq/L citrate) was compared against conventional saline flushing for anticoagulation.
- No systemic heparin was administered; a heparinized dialyzer was used in both groups.
Main Results:
- Both methods were well-tolerated, with 92% (Citrate Group) and 100% (Saline Group) of patients tolerating the procedure.
- Clotting in the extracorporeal circuit occurred in 8% of treatments in both groups.
- Significantly less thrombus formation was observed in venous air traps with the citrate-enriched dialysate.
- No hypocalcemic or bleeding complications were reported; however, ionized calcium and magnesium levels were slightly lower post-dialysis in the citrate group.
Conclusions:
- A simple citrate-enriched dialysate is a feasible and effective method for anticoagulating the extracorporeal circuit during haemodialysis.
- This citrate-based approach offers a simpler alternative to conventional intermittent saline flushing.
- The method appears safe for patients at high risk of bleeding complications.
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