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. 2021 Apr 28;14(12):2534-2538.
doi: 10.1093/ckj/sfab087. eCollection 2021 Dec.

Heparin-free regional anticoagulation of haemodialysis filters with calcium-free dialysate: is citrate mandatory?

Chloé Medrano  1 , Olivier Cointault  1 , Laurence Lavayssiere  1 , Marie-Béatrice Nogier  1 , Eloïse Colliou  1 , Nicolas Setbon  1 , Nassim Kamar  1 , Stanislas Faguer  1
Affiliations

Heparin-free regional anticoagulation of haemodialysis filters with calcium-free dialysate: is citrate mandatory?

Chloé Medrano et al. Clin Kidney J. .

Abstract

Background: There is an unmet need to develop safe and successful heparin-free regional anticoagulation modalities in haemodialysed patients at risk of bleeding. Whether the addition of citrate as a prefilter injection or in the dialysate itself is required to reach anticoagulation objectives when calcium-free dialysate is used as regional anticoagulation remains unclear.

Methods: In this monocentric retrospective study, we report our experience of 908 dialysis sessions performed with a calcium-free citrate-containing dialysate and calcium reinjection according to the ionic dialysance, without additional heparin.

Results: Premature termination for filter clotting occurred in 20 sessions (2.2%) and duration of session was >4.5 h in 135 (15%; maximum duration 6 h). In addition, we could investigate the citrate, calcium and acid-basis status during haemodialysis sessions performed with (citrate group, n = 20 sessions) or without (citrate-free group, n = 19 sessions) citrate in the dialysate. In 20 sessions performed in patients with underlying liver disorders and using calcium-free citrate-containing dialysate, patients' ionized calcium (iCa) and serum citrate levels were stable and remained within the normal range, respectively. Post-filter iCa was below 0.4 mmol/L in 19/20 sessions and citrate was 0.304 mmol/L (range: 0.011; 0.548). In 19 sessions that used calcium and citrate-free dialysate, post-filter iCa was 0.41 mmol/L (0.34; 0.5) and all sessions extended to 4 h or beyond.

Conclusions: Regional anticoagulation of haemodialysis with a calcium-free dialysate and calcium reinjection according to the ionic dialysance is safe. Adding citrate to the dialysate is not mandatory to prevent dialysis circuit clotting in most patients.

Keywords: calcium-free dialysate; citrate; intensive care unit; liver failure.

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Figures

FIGURE 1:
FIGURE 1:
Pre-filter (serum) iCa and citrate, total-to-iCa ratio and post-filter iCa. Samples were collected at the start of the dialysis (H0), after 1 h (H1), at the end of the session (End) and 1 h after the end of session (End + 1 hour).
See this image and copyright information in PMC

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