title: A simple, safe and effective citrate anticoagulation protocol for the genius dialysis system in acute renal failure.
abstract: BACKGROUND
  The Genius dialysis system is a close loop dialysis batch system increasingly used as an intermittent hemodialysis device in intensive care units. The aim of this study was to test the safety and feasibility of a regional citrate anticoagulation protocol with respect to acid-base and electrolyte disarrangements in critically ill patients with acute renal failure. A standard heparin anticoagulation protocol served as control.
  
  
  RESULTS
  In a cross-over study design, 27 acute renal failure patients were allocated to a citrate- and heparin-anticoagulated dialysis sessions (4-6 h). For citrate anticoagulation, a 4% sodium-citrate solution was infused into the arterial line of the extracorporeal circuit. A low calcium dialysate (1 mmol/l) was used for all dialysis sessions. Citrate dosing was adjusted according to the post-filter ionized calcium concentration (targeted values 0.5-0.7 mmol/l). There was no routine calcium substitution. Heparin anticoagulation was started with a heparin-loading dose followed by an individual, patient-adjusted continuous heparin infusion. Electrolyte disarrangements, namely hypernatremia, hypo- and hypercalcemia did not occur in either group. Although the highest bicarbonate levels were achieved during citrate anticoagulation (p = 0.021 versus heparin) the acid base values remained equilibrated in both groups. Filter longevity was excellent and the targeted dialysis time was achieved in all but 1 patient. Citrate anticoagulation was well tolerated with respect to cardiovascular hemodynamics.
  
  
  CONCLUSIONS
  Citrate anticoagulation can be safely and effectively performed during intermittent Genius dialysis. Calcium supplementation is not routinely required.
authors.affiliation: Department of Nephrology, Charité, Humboldt University of Berlin, Berlin, Germany. stanislao.morgera@charite.de
authors.forename: Stanislao
authors.initials: S
authors.lastname: Morgera
authors.forename: Cornelia
authors.initials: C
authors.lastname: Scholle
authors.forename: Christoph
authors.initials: C
authors.lastname: Melzer
authors.forename: Torsten
authors.initials: T
authors.lastname: Slowinski
authors.forename: Lutz
authors.initials: L
authors.lastname: Liefeld
authors.forename: Gerd
authors.initials: G
authors.lastname: Baumann
authors.forename: Harm
authors.initials: H
authors.lastname: Peters
authors.forename: Hans-H
authors.initials: HH
authors.lastname: Neumayer
mesh_terms: D000136:Acid-Base Equilibrium; D058186:Acute Kidney Injury / Q000378:metabolism / Q000628:therapy*; D000925:Anticoagulants / Q000008:administration & dosage*; D002951:Citrates / Q000008:administration & dosage*; D002985:Clinical Protocols; D018592:Cross-Over Studies; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D008875:Middle Aged; D006435:Renal Dialysis / Q000379:methods*
chemical_list: D000925:Anticoagulants; D002951:Citrates; D006493:Heparin