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Kidney Week

Abstract: SA-PO663

Efficacy and Safety of a Citrate Anticoagulation Protocol for Slow Extended Dialysis in AKI Cancer Patients Using Path Batch Hemodialysis: A Case Control Study

Session Information

Category: Dialysis

  • 602 Dialysis for AKI: Hemodialysis, CRRT, SLED, Others


  • Portela Neto, Antonio Abel, University of Sao Paulo Medical School, Sao Paulo, Brazil
  • Caires, Renato Antunes, University State of São Paulo, São Paulo, Brazil
  • Frediani, Marcella Martins, University of Sao Paulo Medical School, Sao Paulo, Brazil
  • Costalonga, Elerson, University State of São Paulo, São Paulo, Brazil
  • Coelho, Fernanda O., University of Sao Paulo Medical School, Sao Paulo, Brazil
  • Burdmann, Emmanuel A., University of Sao Paulo Medical School, Sao Paulo, Brazil
  • Macedo, Etienne, UCSD, San Diego, California, United States
  • Costa e Silva, Veronica T., University of Sao Paulo Medical School, Sao Paulo, Brazil

Few reports have addressed citrate anticoagulation (CA) for hybrid dialysis therapies using Path Batch Hemodialysis (PBH).


Slow extended dialysis (SLED) procedures with a PBH system in adult critically ill AKI cancer patients in the Sao Paulo State Cancer Institute, from January 7 to April 7, 2015, were prospectively followed. Procedures performed with regional CA (4% sodium citrate and dialysate containing calcium at 5 mg/dL) were compared with those using continuous normal saline (NS) as anticoagulation.


Twenty four CA and 27 NS sessions were performed in 11 patients. Baseline patient characteristics were similar, whereas duration, ultrafiltration (UF) and flow prescription were different within CA and NS groups (Table). At the end of CA-SLED, median citrate flow was 310 (280 320) mL/h and systemic ionized calcium (SCai) was 4.20 (3.92 – 4.47) mg/dL. During the SLED procedure, hypocalcemia (SCai < 3.6 mg/dL) and metabolic alkalosis (serum bicarbonate > 30 mEq/L) rates were 8.0% and 4%, respectively (N=96). Interruption of PBH by clotting was recorded in only three (12.5%) of CA-SLED sessions and in six (22.2%) of NS procedures (P=0.363). Filter[V-W1] life was 8.0 (6.0 – 8.0) and 4.0 (2.75 – 5.00)h in the CA and NS groups (P<0.0001), respectively. Hypotension rate (mean blood pressure <70 mmHg) was similar in both groups (12.5% in CA-SLED vs 14.8% in NS group, P=0.811). No major bleeding, arrhythmia or relevant clinical events were observed in neither groups. PBH provided a satisfactory metabolic control in both groups (data not shown)


A CA protocol can be safely and efficiently used in PBH SLED in critically ill cancer patients with AKI. Larger sample size studies including control pcts are needed to establish the benefit of citrate based anticoagulation for PBH SLED procedures.

Characteristics of PBH procedures
 CA-SLED (N=11)NS (N=11)P
Blood/Dialysate flow (ml/min)180 (180 – 195)250 (200 - 250)< 0.001
Prescribed dialysis duration (DD)(hrs)8.0 (6.5 – 8.0)4.0 (4.0 – 5.0)< 0.001
Prescribed UF (L)2.0 (1.5 – 2.5)1.0 (0 – 1.5)0.001
Prescribed/Achieved UF (%)94.3 ± 12.385.8 ± 26.20.461
Prescribed/Achieved DD (%)94.7 ± 11.789.5 ± 15.90.321