ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005


The Latest on X

Kidney Week

Please note that you are viewing an archived section from 2022 and some content may be unavailable. To unlock all content for 2022, please visit the archives.

Abstract: SA-PO464

Efficacy of Regional Citrate Anticoagulation vs. Saline Flushing During Intermittent Hemodialysis on Blood Circuit Clotting Prevention: A Randomized Clinical Trial (The Citra-Saline-IHD)

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis


  • Yoowannakul, Suree, Bhumibol Adulyadej Hospital, Bangkok, Thailand
  • Boonsayomphu, Theerapun, Bhumibol Adulyadej Hospital, Bangkok, Thailand

Conventional hemodialysis requires anticoagulation to prevent clotting in the extracorporeal circuit. For patients who unable to receive heparin anticoagulation during hemodialysis, saline flushing technique is a common practice but clots have been found. Regional citrate anticoagulation (RCA) is effective but not routinely use in dialysis unit. We wished to evaluated the efficacy and safety of regional citrate anticoagulation (RCA) for low flux intermittent hemodialysis using with 1.75 mEq/L dialysate calcium compared to saline flushing technique.


A prospective randomized, open label, cross over study on 144 sessions of 72 HD patients was conducted in hemodialysis unit of Bhumibol Adulyadej hospital. Patients were allocated to RCA group and saline group. Citrate was infused and adjusted according to the degree of anticoagulation and level of ionized calcium within the systemic circuit. Assessment of clot formation in dialysis circuit, blood electrolyte, acid-base balance, treatment time and adverse events were evaluated compared between RCA group and saline group.


No clotting event in the RCA group while 25% (18 of 72 sessions) of saline group had circuit clots and resulted in early termination of dialysis. The citrate infusion rate was 41.6±1.6 mmol/l/min with using 1.75 mEq/L dialysate calcium and infuse post-filter of 10% calcium gluconate rate 30 ml/hr. No incidence of hypernatremia, hypocalcemia and metabolic alkalosis in RCA group.


RCA is safe and more effective for preventing dialysis circuit clots than saline flushing technique. We demonstrated the protocol optimal dose of RCA for low flux hemodialysis with using 1.75 mEq/L dialysate calcium can imply to be the protocol for patients who are contraindicated to the use of heparin anticoagulants in the intermittent hemodialysis.


  • Government Support – Non-U.S.