title: Safe use of citric acid-based dialysate and heparin removal in postdilution online hemodiafiltration.
abstract: BACKGROUND
  Anticoagulation of the blood circuit with heparin is essential for hemodialysis, but exposes patients to several risks (bleeding, thrombocytopenia, etc.). The use of citric acid-based dialysate (CitA-D) allows the reduction of heparin in conventional hemodialysis. We evaluated the feasibility of using CitA-D in postdilution online hemodiafiltration (OL-HDF) and of removing heparin.
  
  
  METHODS
  We prospectively compared chlorhydric acid-based dialysate with CitA-D in 10 patients treated by OL-HDF. First, we reduced heparin by half the dose and then we totally removed anticoagulation.
  
  
  RESULTS
  For all 120 sessions using heparin-free CitA-D, only one clotting episode related to an arteriovenous fistula stenosis was observed. No adverse clinical effect was observed. (Kt/V)sp, predialytic serum bicarbonate, calcium, phosphate, parathroid hormone, and β2-microglobulin remained the same in all cases.
  
  
  CONCLUSIONS
  Our data suggest that the use of CitA-D in OL-HDF is safe and allows heparin removal in most patients.
authors.affiliation: Hemodialysis Center Henri Küntziger, AURA, Paris, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Aniort
authors.forename: Thierry
authors.initials: T
authors.lastname: Petitclerc
authors.forename: Caroline
authors.initials: C
authors.lastname: Créput
mesh_terms: D000368:Aged; D001774:Blood Chemical Analysis; D001777:Blood Coagulation; D019343:Citric Acid / Q000097:blood / Q000737:chemistry*; D005260:Female; D017583:Hemodiafiltration; D015312:Hemodialysis Solutions / Q000009:adverse effects / Q000737:chemistry*; D006493:Heparin / Q000097:blood / Q000378:metabolism*; D006801:Humans; D007674:Kidney Diseases / Q000097:blood / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
chemical_list: D015312:Hemodialysis Solutions; D019343:Citric Acid; D006493:Heparin