title: Regional citrate anticoagulation during hemodialysis: a simplified procedure using Duocart biofiltration.
abstract: BACKGROUND
  Regional citrate anticoagulation during hemodialysis is promising, but its clinical implementation is routinely cumbersome because a continuous adjustment of calcium infusion at the dialyzer outlet is needed. Duocart biofiltration (DCB) is a new hemodialysis method using a calcium and magnesium-free dialysate containing only sodium chloride and bicarbonate combined with the infusion into the venous line of a solution containing the ionic complement (K, Ca, Mg) and glucose. Since the dialysate is calcium- and magnesium-free and infusion rate of the solution containing calcium is automatically determined by the dialysis delivery system according to the on-line measured value of ionic dialysance, DCB seems a technique especially suitable for citrate anticoagulation procedure.
  
  
  METHODS
  Thirty DCB sessions were performed in 10 patients with increased risk of bleeding. A commercially available mixture of trisodium citrate, citric acid and glucose was infused into the arterial line at a rate equal to 3% of dialyzer blood flow. The ionic complement (K: 48 mM, Ca: 42 mM, Mg: 14 mM, glucose: 110 mM) was infused at a rate equal to 1/24 ionic dialysance value automatically determined each 15 min by the dialysis monitor. DCB sessions were compared to 21 conventional bicarbonate hemodialysis (BHD) sessions with low-molecular-weight heparin anticoagulation.
  
  
  RESULTS
  Whole blood activated clotting time (WBACT) measured in the venous line (before infusion of ionic complement) was 200% of the WBACT value in the arterial line. Clotting and citrate-related adverse events were not observed. Postdialysis compression time of the arteriovenous access is significantly (p<0.001) shorter after DCB sessions (3.9+/-1.1 min) compared with BHD sessions (8.7+/-4.6 min).
  
  
  CONCLUSIONS
  Citrate anticoagulation during Duocart biofiltration is effective, safe and suitable for routine use because calcium infusion rate is automatically adjusted without the need of monitoring degree of anticoagulation and level of ionized calcium.
authors.affiliation: Department of Nephrology, Hôpital de la Pitié, Paris, France. christophe.ridel@bct.aphp.fr
authors.forename: Christophe
authors.initials: C
authors.lastname: Ridel
authors.forename: Lucile
authors.initials: L
authors.lastname: Mercadal
authors.forename: Bernard
authors.initials: B
authors.lastname: Béné
authors.forename: Abdelaziz
authors.initials: A
authors.lastname: Hamani
authors.forename: Gilbert
authors.initials: G
authors.lastname: Deray
authors.forename: Thierry
authors.initials: T
authors.lastname: Petitclerc
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002951:Citrates / Q000494:pharmacology*; D005260:Female; D017583:Hemodiafiltration / Q000009:adverse effects; D015312:Hemodialysis Solutions / Q000494:pharmacology*; D006470:Hemorrhage / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D000077559:Sodium Citrate
chemical_list: D002951:Citrates; D015312:Hemodialysis Solutions; D000077559:Sodium Citrate