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Abstract: TH-PO262

Experience Comparing the Use of Citric Acid Solution (CD) with L-Ascorbic Acid (Vitamin C) to Simple Citric Solution in Patients with ESRD Under Hemodialysis (HD)

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis

Author

  • Griveas, Ioannis, Noseleutiko Idryma Metochikou Tameiou Stratou, Athens, Attike, Greece
Background

The purpose of the study is to record the experience of comparing the use of CD solution with Vitamin-C in relation to the use of pure CD solution in patients with ESRD under HD.

Methods

45 patients with ESRD under HD (40 new entrants) receiving CD solution with vitamin-C (2g/lt) for a period of 12 months were compared with 26 patients (18 new entrants) of the same weight who received plain CD solution. Changes in heparin dose as well as the anemia profile of the patients were recorded.

Results

In the vitamin C solution the initial cumulative dose of heparin 1818±659.28 iu (24 iu/kgrBW) to 3323.52±1467.79 iu (44 iu/kgr/BW) at 12 months. With no observed thrombotic events or bleeding tendency, the heparin dose was significantly reduced from classically recommended doses (loading dose 30-50 IU/kgBW and then 10 IU/kgBW/hour). A corresponding observation was also noted in pure CD (29 iu/kgrBW beginning-39 iu/kgrBW end). Hb and Hct increased significantly (10.63±1.55 start-11.79±0.91 end, p<0.05, 32.25±4.45 start-36.5±2.92 end, p<0.05) with constant weekly dose of erythropoietin (14000±9500 iu start-14000±10000 iu end,p=NS) and constant ferritin levels (526.73±498.72 iu start-690.44±470.32 iu end,p=NS). The above notice was combined with a significant reduction in monthly iron administration (200 mg monthly final dose). In CD without Vitamin-C we had corresponding observations with a consistently significantly higher dose of monthly iron administration (400-500 mg final dose).

Conclusion

Our findings suggest that the use of both solutions provides anticoagulation with a significant decrease in heparin while simultaneously increasing hemoglobin with a fixed dose of erythropoietin. The addition of vitamin C is associated with reduced monthly iron intake.