Regional citrate anticoagulation for single-needle hemodialysis: a prospective clinical study.
OBJECTIVE
Regional citrate anticoagulation protocol for single-needle hemodialysis was tested prospectively for safety and efficacy.


METHODS
15 chronic dialysis patients at risk of bleeding were included. 4% trisodium citrate (200 ml/h), calcium-free dialysate and 1 mol/l calcium chloride (7 ml/h) were used. After dialysis the antithrombotic effect in the circuit was assessed visually (grade 5, no clotting, to 1, total occlusion) and serum citrate was measured.


RESULTS
Of 32 dialyses performed, 94% were uneventful and in 2 cases (6%) there was severe (ionized calcium < or = 0.8 mmol/l) but asymptomatic hypocalcemia. Mean anticoagulation score after dialysis was 4.8 +/- 0.7 for the arterial bubble trap, 4.6 +/- 0.8 for the dialyzer and 4.8 +/- 0.7 for the venous bubble trap. Serum citrate after dialysis was 158 +/- 60 micromol/l.


CONCLUSIONS
Regional citrate anticoagulation in single-needle dialysis is safe and efficient.
Gubensek
Jakob
J
Department of Nephrology, Center for Dialysis, University Medical Centre Ljubljana, Ljubljana, Slovenia. jakob.gubensek@kclj.si
Buturovic-Ponikvar
Jadranka
J
Ponikvar
Rafael
R
D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D002951:Citrates / Q000627:therapeutic use*; D005260:Female; D015312:Hemodialysis Solutions / Q000737:chemistry* / Q000494:pharmacology*; D006470:Hemorrhage; D006801:Humans; D006996:Hypocalcemia; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods*
D000925:Anticoagulants; D002951:Citrates; D015312:Hemodialysis Solutions; C514290:trisodium citrate