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Kidney Week

Abstract: TH-PO264

Citrate-Acidified Dialysate Requires Less Heparin Use Without Affecting Mineral Metabolism Negatively

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Woitas, Rainer P., Diaverum Germany, Munich, Germany
  • Haarhaus, Mathias, Diaverum Renal Services Group, Malmö, Sweden
  • Capin, Dario, Diaverum Germany, Munich, Bayern, Germany
  • Macario, Fernando Jose Gordinho Rocha M, Diaverum Renal Services Group, Malmö, Sweden
Background


Heparin is used to prevent clotting in hemodialysis, but may cause bleeding, thrombocytopenia, and skeletal complications.
Citrate-acidified dialysate (CAD) compared to acetate-acidified dialysate (AAD) may improve hemodynamic stability and reduce inflammation. Citrate has calcium complexing properties in regional anticoagulation, yet its use may affect mineral metabolism negatively. We studied the effect of a dialysis bath with low concentrations of citrate on heparin use and mineral metabolism.

Methods

207 prevalent ESRD pts. (182 with high flux dialysis (HD), 25 with post dilution hemodiafiltration ( HDF)) were followed for 48 weeks after switching from AAD (3mmol/l acetate) to CAD (0.8 mmol/l citrate, 0.3 mmol/l acetate; MTN, Germany). We monitored heparin consumption, KT/V, CRP, iPTH, phosphate, magnesium, and calcium as well as side effects.

Results

The cohort comprised 127 males and 81 females, mean age 71.6 years (range 25 – 95). Mean treatment time was 254 minutes per session (range 180– 00) and mean blood flow at baseline 360 mL/min (range 250 -420) vs. 254 minutes (range 180–300) and 370 ml/min (range 240-420) at 48 weeks. Mean initial heparin dosing per session was 5171 IU (95%CI 4836-5507) in HD and 6720 IU (95%CI 5920-7520) in HDF. This could be reduced step by step to a mean of 2985 IU (95%CI 2723-3246) in HD and 3375 IU 95%CI 2867-3883) in HDF (after 48 weeks (p<0.005 for HD and HDF).
CRP was higher (p<0.05) in HD pts. than in HDF pts. at start. It increased during the observation in HD (8.0 vs. 15.0, n.s. after 48 weeks), but not in HDF (CRP start 2.7mg/l vs. 4.2mg/l after 48 weeks, n.s.). In neither group magnesium, calcium, phosphate, iPTH nor KT/V changed significantly. During the observation period 7 pts. (3.4%) were intolerable to CAD, 11 withdraw for unknown reasons (5.3%), 11 pts. (5.3%) left the clinic, 1 patient switched to CAPD (0.5%), 3 (1.4%) were transplanted and 32 died (15.38%).

Conclusion

Under CAD heparin-dosing could be reduced markedly. This may be beneficial for the patient and reduce treatment costs. Long-term treatment with a low-concentration CAD was well tolerated and did not exacerbate secondary hyperparathyroidism. Further long-term studies are ongoing to assess effects on calcification, morbidity, and mortality.