Citrate anticoagulation during in vivo simulation of slow hemofiltration

Citrate anticoagulation has been used as an alternative to heparin for hemodialysis in high-risk patients; however, its use in hemofiltration has not been well studied. We examined citrate in 6 patients placed on slow hemofiltration for up to 6 h duration. During the experiments, the systemic citrate level increased from a baseline average of 0.15 to 0.55 mmol/l, and then decreased to 0.27 mmol/l. The citrate was freely filtered. The systemic total and ionized calcium decreased very slightly and no untoward effects were noted. Anticoagulation was successful. This preliminary study suggests that citrate anticoagulation can be used in slow hemofiltration.