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Inpatient citrate-based hemodialysis in pediatric patients

Cecile Fajardo1, Cheryl P Sanchez1, Drew Cutler1

  • 1Department of Pediatrics, Loma Linda University Children's Hospital, Loma Linda, CA, 92354, USA.

Pediatric Nephrology (Berlin, Germany)
|May 12, 2016
PubMed

Insights

Citrate-based dialysate offers a safe alternative for pediatric hemodialysis (HD) anticoagulation, showing low rates of thrombosis and mild hypocalcemia. This method is well-tolerated in hospitalized children requiring HD.

Area of Science:

  • Pediatric Nephrology
  • Renal Replacement Therapy
  • Clinical Pharmacology

Background:

  • Citrate-based dialysate is an established hemodialysis (HD) anticoagulation method for adults.
  • Heparin anticoagulation is commonly used in pediatric HD but carries risks.
  • Evaluating citrate dialysate as a safer alternative in pediatric patients is crucial.

Purpose of the Study:

  • To assess the efficacy and safety of citrate-based dialysate for anticoagulation in pediatric hemodialysis.
  • To compare citrate dialysate with heparin anticoagulation in terms of thrombosis and complications.
  • To determine the feasibility of using citrate dialysate in hospitalized pediatric patients.

Main Methods:

  • A prospective, non-randomized study involving 18 pediatric patients (0-18 years) undergoing 119 citrate-based dialysate HD treatments.
  • Primary outcomes included thrombosis incidence leading to circuit or catheter loss, or dialysis termination.
  • Secondary outcomes measured were hypocalcemia and the need for additional heparin.

Main Results:

  • Low rates of thrombosis-related circuit loss (2.5%), catheter loss (2.5%), and early dialysis termination (5.9%) were observed.
  • Circuit clots occurred in 64% of treatments without loss; mild, asymptomatic hypocalcemia developed in 58% of sessions.
  • No additional heparin was required during citrate HD, though 11.1% were later switched to heparin.

Conclusions:

  • Citrate-based dialysate demonstrated a low incidence of severe thrombotic events in pediatric hemodialysis.
  • While hypocalcemia was frequent, it was mild and asymptomatic, indicating good tolerability.
  • Citrate-based dialysate is a safe and effective alternative to heparin for anticoagulation in pediatric HD patients.
Abstract

Keywords:
AnticoagulationCitrateDialysis complicationsHemodialysisPediatric dialysis

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