A Significant Proportion of Patients Treated with Citrate Containing Dialysate Need Additional Anticoagulation

Stegmayr, Bernd; Jönsson, Per; Mahmood, Dana

doi:10.5301/ijao.5000172

Cited by 20 publications

(30 citation statements)

References 16 publications

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“…Citrate has several advantages over acetate, including local anticoagulant properties that allow a decrease or even removal of anticoagulation for HD, lower peripheral resistance and better blood pressure control during the procedure [6,7,8,9,10]. Another advantage is an increased HD efficiency when citrate dialysate is used [5].…”

Section: Introductionmentioning

confidence: 99%

Changes of Serum Calcium, Magnesium and Parathyroid Hormone Induced by Hemodialysis with Citrate-Enriched Dialysis Solution

Šafránek¹,

Moučka²,

Vávrová³

et al. 2015

Kidney Blood Press Res

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Background/Aims: In recent years, one of technical attempts to improve biocompatibility and tolerability of the hemodialysis procedure is the substitution of acetate in dialysis solution with citrate. The aim of our study was to compare two dialysis solutions: traditional bicarbonate dialysis solution containing acetate (3 mmol/L) (solution A); and (solution C) commercially produced citrate-enriched bicarbonate dialysis solution (0.8 mmol/L citrate). Methods: Patients from a single hemodialysis center (N=126) were included in the study. Both conventional low-flux hemodialysis and on-line hemodiafiltration procedures were studied. Both dialysis solutions contained identical calcium (1.5 mmol/L) and magnesium (0.5 mmol/L) concentrations. Results: Parathyroid hormone (iPTH) concentration decreased during procedures with solution A by 64%. On the contrary, when solution C was used, iPTH concentration increased insignificantly by 4%. For solution A, serum calcium and magnesium increased during procedures in patients with predialysis concentrations lower than 2.33 and 0.76 mmol/L, respectively. In procedures with dialysis solution C these concentrations were significantly lower: 2.19 mmol/L for Ca and 0.68 mmol/L for Mg. Conclusion: Our study clearly shows that the substitution of part of acetate with citrate in dialysis solution significantly influences changes of serum calcium, magnesium and parathyroid hormone concentrations during hemodialysis and hemodiafiltration procedures.

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Section: Introductionmentioning

confidence: 99%

Changes of Serum Calcium, Magnesium and Parathyroid Hormone Induced by Hemodialysis with Citrate-Enriched Dialysis Solution

Šafránek¹,

Moučka²,

Vávrová³

et al. 2015

Kidney Blood Press Res

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“…Numerous reports have demonstrated that CD is associated with decreased clotting of the HD circuit in comparison with the conventional intermittent saline-flushing treatment [2], increased small and medium solute clearance [3], decreased acidosis [4], and improved anemia [5]. Because CD has gained popularity and its effect on heparin dose is unclear, we aimed to de-DOI: 10.1159/000495025 termine the minimum heparin dose that can be used with CD, considering the possibility of avoiding heparin altogether. The secondary outcomes assessed were the effects of CD on other parameters: acid-base derangement, adequacy of dialysis, and hemoglobin level.…”

mentioning

confidence: 99%

The Effect of Citrate on Clot Formation, Dialyzer Reuse, and Anemia in Hemodialysis Patients

Trakarnvanich

Thirathanakul

Sriphueng³

et al. 2018

Blood Purif

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Background: Citrate anticoagulation is increasingly favored for preventing extracorporeal circuit clotting during renal replacement therapy. This study tested the effect of citrate compared with acetate on heparin avoidance and other parameters. Methods: Sixty-one chronic hemodialysis (HD) patients were switched from conventional dialysis fluid (acetate) to citrate dialysis fluid and were treated in 3 phases, each lasting 4 weeks: 50%, 25%, and no heparin. Visual clotting score, erythropoiesis stimulating agent (ESA) dose, and laboratory parameters were measured. Results: Except for 2 episodes of clotting, the same dialyzers were used throughout each citrate phase. The mean visual clotting scores were comparable across study periods. Hemoglobin decreased slightly in phase 2 despite the constant ESA dose. The ionized calcium levels rose after HD in most sessions. No adverse events occurred during citrate dialysis. Conclusion: During citrate dialysis in chronic HD patients, heparin can be completely avoided. The electrolyte levels, the adequacy of dialysis, and hemoglobin can be maintained without significant adverse events.

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“…Citrate-enriched dialysate, compared to intermittent saline flushes given to patients with a high-risk of bleeding, has also been associated with less thrombus formation in venous air traps [21]. However, another study showed that a significant proportion of patients treated with citrate-dialysate, compared to dialysis with low molecular-weight heparin, needed additional anticoagulation due to clot formation although the URR did not differ between these groups [1]. Moreover, Evenepoel et al [10] showed that citrate, when used as RCA, led to a lower clotting rate necessitating premature termination of the dialysis session compared to the use of heparin-coated AN69ST membranes.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have shown that citrate dialysate is associated with a decreased need for anticoagulation, and hence there is a lesser risk of clotting within the HD circuit [11]. Citrate dialysate is also well tolerated [1,12,13]. It is not associated with the development of severe calcium or acid-base disorders, even when higher citrate loads are used [14].…”

Section: Introductionmentioning

confidence: 99%

“…The interactions between blood and dialyzer membranes in the extracorporeal system activate several cascade systems, including the coagulation system [1]. Thus, anticoagulation is important to minimize clotting of the extracorporeal circuit, although patients with end-stage renal disease and receiving dialysis already have an increased risk of excess bleeding.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of the AN69ST Membrane versus Citrate-Enriched Dialysate on Clotting Events during Hemodialysis without Systemic Anticoagulation

Nseir

Rachas²,

Elias³

et al. 2017

Blood Purif

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Background: The optimal management of anticoagulation in hemodialyzed patients with a high risk of bleeding is controversial. Methods: We compared premature termination of dialysis caused by clotting events between AN69ST membranes (G1) and 0.8 mmol/L citrate-enriched dialysate (G2). The number of sessions that had increased venous pressure (VP) and variations in urea-reduction ratio (URR) were analyzed. Results: Six hundred and two sessions were analyzed in 259 patients: 22.4% had sessions that ended prematurely (25% in G1 and 19.1% in G2, p = ns, OR 0.60 [0.34-1.08], p = 0.08). The increase in VP was lower in G2 (23 vs. 70, p < 0.001). URR was higher in G2 (0.56 vs. 0.60, p < 0.001). Conclusion: Clotting events that led to the termination of dialysis were comparable in the 2 groups. However, UUR was better in G2, and the number of patients with increased VP in the sessions was lower in G2. Short Summary: Our study compared the effects of the AN69ST membrane and citrate-enriched dialysate on clotting events during the dialysis of 259 patients with a high risk of bleeding. URR was significantly better and fewer cases of increased VP occurred in the citrate group compared to the AN69 ST group. No significant difference was observed regarding the need to prematurely terminate a dialysis session.

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A Significant Proportion of Patients Treated with Citrate Containing Dialysate Need Additional Anticoagulation

Abstract: A significant proportion of patients treated with citrate-containing dialysate need additional anticoagulation.

Cited by 20 publications

References 16 publications

Changes of Serum Calcium, Magnesium and Parathyroid Hormone Induced by Hemodialysis with Citrate-Enriched Dialysis Solution

Changes of Serum Calcium, Magnesium and Parathyroid Hormone Induced by Hemodialysis with Citrate-Enriched Dialysis Solution

The Effect of Citrate on Clot Formation, Dialyzer Reuse, and Anemia in Hemodialysis Patients

Comparison of the AN69ST Membrane versus Citrate-Enriched Dialysate on Clotting Events during Hemodialysis without Systemic Anticoagulation

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