Regional anticoagulation with calcium-free dialysate containing citrate in chronic haemodialysis patients

Scarfoglière, Violaine; Bobot, Mickaël; Cavaille, Guilhem; Bouchouareb, D.; Brunet, Philippe; Robert, Thomas

doi:10.1093/ndt/gfaa365

Cited by 4 publications

(7 citation statements)

References 13 publications

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“…Consequently, a novel simplified technique involving a calcium-free citrate-containing dialysate with calcium reinjection into the venous line based on ionic dialysance has emerged, yielding promising results [ 20 , 21 , 22 , 23 ]. The absence of calcium in the dialysate forestalls coagulation within the dialyzer and the circuit when ionized serum calcium falls below 0.4 mmol/L [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…Scarfogliere et al [ 21 ] further validated the efficacy and safety of this hemodialysis technique in a retrospective study involving 21 patients, conducting a cross-over comparison of dialysis sessions employing calcium-free citrate dialysate versus heparin. A dialysis session success rate of 94% was noted with calcium-free citrate dialysate compared to 97% with heparin ( p = 0.22).…”

Section: Discussionmentioning

confidence: 99%

“…A technique of heparin-free anticoagulation using a calcium-free, citrate-containing dialysate with calcium reinjection into the venous line has shown promising results in recent years [ 20 , 21 , 22 , 23 ], allowing for proper anticoagulation of the circuit with minimal impact on patients’ ionized calcium levels (iCa). The absence of calcium in the dialysate creates a significant diffusive gradient, facilitating the transfer of calcium from the blood to the extracorporeal system, thereby preventing coagulation.…”

Section: Introductionmentioning

confidence: 99%

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Calcium-Free Dialysate Hemodialysis: A Simplified Approach

Corbu,

Terrec,

Malvezzi

et al. 2024

JPM

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Intermittent hemodialysis (HD) in high-bleeding-risk patients presents a challenge as circuit anticoagulation using heparin is contraindicated in such cases. Recently, the use of calcium-free citrate-containing dialysate with calcium supplementation emerged as a viable alternative to heparin-circuit anticoagulation. This is a retrospective, monocentric study to evaluate dialysis efficacy using calcium-free citrate-containing dialysate with calcium reinjection into the venous line in hemodialysis patients at risk of bleeding. A total of 53 patients were analyzed: 52 had a temporary contraindication to systemic anticoagulation (active bleeding or surgical intervention), and 1 chronic HD patient had prolonged bleeding time due to inoperable arteriovenous fistula stenosis. Only 7 out of 79 dialysis sessions performed were prematurely terminated (vascular access dysfunction). The median dialysis time was 240 min (range: 150–300). The chronic dialysis patient had 108 sessions with no premature termination. Frequent monitoring of ionized calcium was performed throughout the dialysis sessions: levels remained stable at T0 and T + 60 min (1.08 ± 0.08 mmol/L) and slightly increased at the end of the dialysis session (1.19 ± 0.13 mmol/L), remaining within normal limits. Target postfilter ionized calcium <0.4 mmol/L was achieved in all sessions (0.31 ± 0.07 mmol/L). There were no cases of symptomatic hypo-/hypercalcemia and no need for calcium infusion rate adjustment throughout the sessions. Hemodialysis with calcium-free citrate-containing dialysate and calcium reinjection into the venous line is efficient and safe in HD patients with contraindications to systemic anticoagulation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Calcium-Free Dialysate Hemodialysis: A Simplified Approach

Corbu,

Terrec,

Malvezzi

et al. 2024

JPM

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“…Another simplification is proposed by Scarfoglière et al, who have developed a simplified procedure based on a fixed calcium infusion rate. 10 Indeed, they observed that ID is almost constant at around 210 mL/min for a blood flow of 300 mL/min during a dialysis session using a highflux dialyzer. By setting the infusion rate of a 10% calcium chloride solution (calcium concentration: 457 mmol/L) at 0.7 mL/min, the calcium influx is 0.32 mmol/min, which for ID = 210 mL/min corresponds to a calcium balance equivalent to that obtained with dialysate calcium at 1.5 mmol/L (according to Equation [1]).…”

Section: Other Simplificationsmentioning

confidence: 99%

“…Another simplification is proposed by Scarfoglière et al., who have developed a simplified procedure based on a fixed calcium infusion rate 10 . Indeed, they observed that ID is almost constant at around 210 mL/min for a blood flow of 300 mL/min during a dialysis session using a high‐flux dialyzer.…”

Section: Other Simplificationsmentioning

confidence: 99%

Can regional anticoagulation with calcium‐free dialysate be extended to maintenance hemodialysis?

Petitclerc,

Béné

2024

Artificial Organs

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BackgroundRegional anticoagulation in hemodialysis avoids the use of heparin, which is responsible for both hemorrhagic and non‐hemorrhagic complications. Typically, blood is decalcified by injecting citrate into the arterial line of the extracorporeal circuit. Calcium‐free dialysate improves anticoagulation efficacy but requires injection of a calcium‐containing solution into the venous line and strict monitoring of blood calcium levels. Recent improvements have made regional anticoagulation with calcium‐free dialysate safer and easier.Observations(1) Adjusting the calcium injection rate to ionic dialysance avoids the risk of dyscalcemia, thus making unnecessary the monitoring of blood calcium levels. This adjustment could be carried out automatically by the hemodialysis monitor. (2) As calcium‐free dialysate reduces the amount of citrate required, this can be supplied by dialysate obtained from currently available concentrates containing citric acid. This avoids the need for citrate injection and the risk of citrate overload. (3) Calcium‐free dialysate no longer needs the dialysate acidification required for avoiding calcium carbonate precipitation in bicarbonate‐containing dialysate.ConclusionsRegional anticoagulation with calcium‐free dialysate enables an acid‐ and heparin‐free procedure that is more biocompatible and environmentally friendly than conventional bicarbonate hemodialysis. The availability of specific acid‐free concentrates and adapted hemodialysis monitors is required to extend this procedure to maintenance hemodialysis.

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