title: Anticoagulation during haemodialysis using a citrate-enriched dialysate: a feasibility study.
abstract: BACKGROUND
  The feasibility of anticoagulating the extracorporeal circuit during haemodialysis using a simple citrate-enriched dialysate was evaluated in a prospective, randomised, cross-over study of 24 patients who were at high risk for bleeding.
  
  
  METHODS
  A dialysate, with a citrate level of 3 mEq/L (1 mmol/L), was generated by adding citrate to the conventional liquid 'bicarbonate concentrate' of a regular, dual-concentrate, bicarbonate-buffered dialysate delivery system. Each of the 24 patients received two dialysis treatments. For anticoagulation of the extracorporeal circuit, one treatment used the citrate-enriched dialysate (Citrate Group), while the other treatment used conventional saline flushing (Saline Group). The order of the two treatments was randomised. With either method, a heparinized, saline-rinsed dialyser was used, and no heparin was administered during dialysis.
  
  
  RESULTS
  Ninety-two per cent (22 out of 24) and 100% of patients tolerated the procedure well in the Citrate Group and the Saline Group, respectively. Eight per cent (two out of 24) of the treatments in each group had to be abandoned because of clotting in the extracorporeal circuit. Significantly less thrombus formation in the venous air traps was detected in the Citrate Group. No patients from either group suffered from hypocalcaemic or bleeding complications, but the immediate post-dialysis and 0.5-h post-dialysis plasma levels of ionised calcium and of magnesium were slightly lower in the Citrate Group than in the Saline Group.
  
  
  CONCLUSIONS
  Our findings suggest that it is feasible to use the present simple citrate-enriched dialysate to dialyse patients safely and effectively. Furthermore, the approach is much simpler than a conventional, intermittent, saline-flushing method.
authors.affiliation: Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Chinese University of Hong Kong, Hong Kong, China. chengyl1@ha.org.hk
authors.forename: Yuk-Lun
authors.initials: YL
authors.lastname: Cheng
authors.forename: Alex W
authors.initials: AW
authors.lastname: Yu
authors.forename: Kwong-Yuen
authors.initials: KY
authors.lastname: Tsang
authors.forename: Dilip H
authors.initials: DH
authors.lastname: Shah
authors.forename: Carl M
authors.initials: CM
authors.lastname: Kjellstrand
authors.forename: Siu-Man
authors.initials: SM
authors.lastname: Wong
authors.forename: Wai-Yan
authors.initials: WY
authors.lastname: Lau
authors.forename: Lap-Man
authors.initials: LM
authors.lastname: Hau
authors.forename: Todd S
authors.initials: TS
authors.lastname: Ing
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000494:pharmacology*; D001777:Blood Coagulation / Q000187:drug effects; D019343:Citric Acid / Q000494:pharmacology*; D018592:Cross-Over Studies; D015314:Dialysis Solutions / Q000494:pharmacology*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis
chemical_list: D000925:Anticoagulants; D015314:Dialysis Solutions; D019343:Citric Acid