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
- Hemodialysis and Frequent Dialysis: Clearance, Technology, Infection
November 05, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Yoowannakul, Suree, Bhumibol Adulyadej Hospital, Bangkok, Thailand
- Boonsayomphu, Theerapun, Bhumibol Adulyadej Hospital, Bangkok, Thailand
Background
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.
Methods
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.
Results
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.
Conclusion
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.
Funding
- Government Support – Non-U.S.