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Kidney Week

Abstract: FR-PO734

The Effect of Citrate Dialysate on Clot Formation and Anemia in Hemodialysis Patients

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis


  • Trakarnvanich, Thananda, Vajira Hospital, Bangkok, Thailand

Group or Team Name

  • Hemodialysis Nurses team at Vajira Hospitl,Ruenrudee Clinic and Bangpai Hospital

Citrate anticoagulation in renal replacement therapy is increasingly becoming a favorite choice to prevent extracorporeal circuit clotting. The use of citrate rendered the reduction of heparin in conventional hemodialysis. This is a study to test the effect of citrate on heparin avoidance and other parameters such an ESA dose, anemia, adequacy of dialysis, and inflammatory cytokines compared to acetate dialysate.


Sixty one chronic HD patients were switched from acetate to citrate dialysate and treated in 3 phases, with each phase lasting for four weeks. These phases comprised 50% and 25% heparin reduction and heparin free treatments. Visual clotting score, as graded by a visual analog scale, ESA doses and laboratory data including pre- and post-HD ionized calcium levels,IL-6 and hs-CRP were measured


Except for two episodes of clotting, the dialyzers could be used thoroughly throughout the citrate phases. The mean visual clotting scores for all three study periods were comparable. Hemoglobin decreased slightly in phase 2 (9.68+1.88 VS 9.06+1.60 g/dL, p=0.001, pre and post protocol) despite constant ESA dose.
There were no significant differences in electrolytes, adequacy of dialysis, and inflammatory cytokine levels, as measured by IL-6 and hs CRP between acetate and citrate dialysis. The post protocol level of iCa 2+ paradoxically rose after HD in most sessions. We observed no adverse events during citrate dialysis.


During periods of citrate dialysis in chronic HD patients, heparin can be avoided while maintaining balanced electrolyte levels and adequacy of dialysis and hemoglobin. No significant adverse events, including hypocalcemia, were found.


  • Government Support - Non-U.S.