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Citrate anticoagulation and divalent cations in hemodialysis
M J Janssen1, P C Huijgens, A A Bouman
1Department of Nephrology, Free University Hospital, Amsterdam, The Netherlands.
Blood Purification
|January 1, 1994
Summary
Magnesium may reduce citrate
Area of Science:
- Nephrology
- Hematology
- Biochemistry
Background:
- Citrate anticoagulation is used in hemodialysis for patients at high bleeding risk.
- Magnesium's potential to antagonize citrate's anticoagulant effect requires investigation.
Purpose of the Study:
- To investigate the in vitro and in vivo interactions of calcium and magnesium on citrate anticoagulation.
Main Methods:
- In vitro studies using activated partial thromboplastin time (APTT) and Lee-White blood clotting time.
- In vivo studies in chronic hemodialysis patients measuring whole blood activated clotting time (ACT).
Main Results:
- Magnesium and calcium individually prolonged APTT, but their combination was less effective than calcium alone.
- Citrate's anticoagulant effect was neutralized by a calcium-magnesium mixture or calcium chloride alone.
- In vivo, ACT was shorter with Ca-Mg+ dialysate compared to Ca-Mg- dialysate.
Conclusions:
- Magnesium may interfere with citrate anticoagulation.
- Careful management of calcium and magnesium levels is crucial during citrate anticoagulation in hemodialysis.