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Is Anticoagulation Discontinuation Achievable with Citrate Dialysate during HDF Sessions?

Thibault Dolley-Hitze1, Emmanuel Oger2, Didier Hamel1

  • 1AUB Santé, Saint-Malo Dialysis Unit, 1 rue de la Marne, 35400 Saint-Malo, France.

International Journal of Nephrology
|November 3, 2016
PubMed

Insights

Citrate dialysate in hemodiafiltration did not allow for reduced anticoagulation and increased clotting events. However, it showed no significant side effects on mineral metabolism or red blood cell production.

Area of Science:

  • Nephrology
  • Clinical Chemistry

Background:

  • Citrate dialysate is an alternative to acetate and HCl concentrates for hemodiafiltration.
  • Online Post-dilution Hemodiafiltration (OL-POST-HDF) using citrate presents challenges regarding anticoagulation management and calcium metabolism.

Purpose of the Study:

  • To evaluate the impact of citrate dialysate on anticoagulation, clotting events, and metabolic parameters in OL-POST-HDF patients.

Main Methods:

  • A 1-year retrospective monocentric study of patients undergoing OL-POST-HDF with citrate dialysate.
  • Analysis included patients with reduced nadroparin dosage.
  • Data collected: clotting events, serum calcium, parathyroid hormone (PTH), hemoglobin, C-reactive protein (CRP), and depuration parameters.

Main Results:

  • Nadroparin dose reduction or withdrawal was linked to increased clotting events.
  • Vitamin K antagonists demonstrated a protective effect against clotting.
  • No significant adverse effects on calcium metabolism, PTH, hemoglobin, or CRP were observed.

Conclusions:

  • Citrate dialysate in OL-POST-HDF does not permit anticoagulation discontinuation or reduction.
  • Citrate dialysate is safe concerning mineral bone metabolism and erythropoiesis.
  • Careful anticoagulation management is still necessary during OL-POST-HDF with citrate.

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