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Kidney Week

Abstract: SA-PO1067

Evaluation of NATEM (ROTEM Delta) in Whole, Non-Citrated Blood in Hemodialysis Patients During Citrate and Dalteparin Anticoagulation

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis


  • De Jong, Gijs M.T., Albert Schweitzer Hospital, Dordrecht, Netherlands
  • Vermeer, Henricus Jan, Albert Schweitzer Hospital, Dordrecht, Netherlands
  • Korte, Mario R., Albert Schweitzer Hospital, Dordrecht, Netherlands
  • van Rosmalen, Joost, Erasmus MC, Rotterdam, Netherlands
  • Meulen, Jan Van der, Albert Schweitzer Hospital, Dordrecht, Netherlands

Standard clotting tests are performed in citrated blood. To investigate clotting in a study comparing citrate vs dalteparin anticoagulation during hemodialysis (HD), a NATEM in whole blood was developed using non-citrated blood. This study evaluates this NATEM.


12 HD patients on anticoagulants (6 vit. K antagonist; 6 acetylsalicylic acid), underwent 2 standard HD sessions with dalteparin and 2 sessions using a Ca/Mg-free, 0.8 mmol/l citrate containing dialysis fluid with Ca/Mg substitution at the venous needle. Before, during and after HD, blood was taken for NATEM (ROTEM Delta, Tem-innovations Munich) in non-citrated (NC-) and citrated tubes (NC+). Clotting time (CT) is the time from starting the measurement until clot formation starts. Clot formation time (CFT) is the time from CT until a clot firmness of 20 mm is reached. Alpha is the angle of tangent between 0 mm and the curve when the clot firmness is 20 mm. A10 and A20 describe the clot firmness after 10 and 20 minutes. Maximum clot firmness (MCF) is the greatest vertical amplitude. NC+ within 10 minutes of NC- were considered to be simultaneous measurements. Data were analyzed using linear mixed models to account for repeated measurements and using linear regression to assess bias between methods. Median (M) and interquartile range (IQR) are reported.


NC- CT (n=130; M 1116 , IQR 942 – 1455 sec) and NC+ CT (n= 126; M 937, IQR 747 – 1281 sec) were correlated (Spearman rho 0.71; p<0.001). There was a constant and a proportional bias with NC- CT giving higher values than NC+ CT. After 45-60 minutes 2 duplicate NC+ were performed. The mean of these CT values (n= 43; M 546, IQR 448 – 776 sec) showed a significant constant bias towards the initial NC+ indicating a decrease of CT in time. Spearman rho correlations between NC- and NC+ were for CFT 0.44, alpha 0.53, A10 0.52, A20 0.58 and MCF 0.63 (p < 0.001).


(Anti)coagulation in citrate HD can be measured with NATEM in whole, citrated blood (NC+), NATEM (NC-) in whole, non-citrated blood can be done but is not necessary. However; results in NC+ change over time. This dictates that NC+ should be performed at a set time after sample collection.


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