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Citrate haemodialysis
L M Faber1, P M de Vries, P L Oe
1Department of Internal Medicine, Free University Hospital, Amsterdam.
Insights
Sodium citrate is a suitable anticoagulant for hemodialysis in high-risk bleeding patients. However, prolonged use may cause paresthesias due to metabolic alkalosis and low calcium, requiring dialysate adjustments.
Area of Science:
- Nephrology
- Hematology
Background:
- Patients undergoing hemodialysis often require anticoagulation.
- High-risk bleeding patients present challenges for standard anticoagulation methods like heparin.
Purpose of the Study:
- To evaluate the efficacy and safety of sodium citrate as an anticoagulant in hemodialysis for patients at high risk of bleeding.
- To compare citrate anticoagulation with heparin anticoagulation in prolonged hemodialysis sessions.
Main Methods:
- Retrospective analysis of 15 high-risk bleeding patients undergoing hemodialysis with sodium citrate.
- Comparison of the last month of heparin dialysis with the first month of citrate dialysis in six patients on prolonged treatment.
Main Results:
- Sodium citrate proved suitable as an anticoagulant in this high-risk group.
- Prolonged citrate dialysis led to paresthesias, likely linked to citrate-induced metabolic alkalosis and hypocalcemia.
- Adjustments to dialysate composition (reduced acetate, calcium- and magnesium-free) are suggested to mitigate side effects.
Conclusions:
- Sodium citrate is a viable anticoagulant option for hemodialysis in bleeding-risk patients.
- Careful monitoring and dialysate modification are necessary to manage side effects during prolonged citrate anticoagulation.
Abstract:
We describe our experience with sodium citrate as anticoagulant in the haemodialysis of 15 patients who were at high risk for bleeding. Furthermore, in six of these patients who were on prolonged citrate dialysis, the last month of heparin dialysis was compared with the first month in which citrate was used as anticoagulant. Our series confirms the suitability of citrate as anticoagulant in patients who are at high risk for bleeding. In the prolonged citrate dialysis group, however, there were complaints of paraesthesias. Probably, the citrate-induced metabolic alkalosis and the relatively low serum calcium concentration observed in these patients contributed to these complaints. To limit these side effects the acetate concentration in the dialysate needs to be reduced and, as magnesium also complexes with citrate, a calcium- and magnesium-free dialysate should be used to reduce the citrate infusion rate and thus the alkaline load in these patients. Furthermore, lowering the calcium infusion rate in order to lower the citrate infusion rate is not indicated because this induces low serum calcium concentration.