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[Regional anticoagulation with sodium citrate: chronic utilization in the hemodialysis patient]
1Clinique de Néphrologie-Dialyse, Hôpital Universitaire Brugmann, Bruxelles.
Insights
This study explored regional citrate anticoagulation in bleeding-risk patients, finding no bleeding or citrate complications. Hemoglobin and hematocrit improved without transfusions, indicating a safe and effective alternative.
Area of Science:
- Nephrology
- Hematology
- Critical Care Medicine
Background:
- Patients with chronic bleeding risks often face challenges with anticoagulation during dialysis.
- Regional citrate anticoagulation (RCA) is an alternative to heparin, but its safety in high-risk patients requires further investigation.
Observation:
- An alternative regional citrate anticoagulation technique (0.48 Mol citrate; 1.75 Mmol Ca in dialysate) was applied to three patients with chronic bleeding risks.
- The patients were monitored for a mean follow-up period of ten months.
Findings:
- No instances of bleeding recurrence were observed in any of the patients.
- No complications associated with citrate anticoagulation were reported.
- Hemoglobin and hematocrit levels increased, negating the need for blood transfusions.
- Serum bicarbonate levels showed an increase within the initial four months of treatment.
- Serum calcium and sodium concentrations remained stable throughout the study period.
Implications:
- This alternative RCA protocol appears safe and effective for hemodialysis patients with chronic bleeding risks.
- RCA may offer a viable anticoagulation strategy, potentially improving hematological parameters and reducing transfusion requirements.
- Further research with larger cohorts is warranted to confirm these findings and establish RCA as a standard of care in specific patient populations.
Abstract:
We used an alternative technique for regional citrate anticoagulation (citrate 0.48 Mol; bicarbonate containing dialysate with Ca 1.75 Mmol) in three patients at chronic risk of bleeding and for a mean follow-up period of ten months. No bleeding recurrence was observed nor any complication related to citrate. Hemoglobin and hematocrit rose without transfusions. Serum bicarbonate increased during the first four months of treatment. No significant change was observed in serum calcium nor serum sodium concentration.