Document Detail

A significant proportion of patients treated with citrate containing dialysate need additional anticoagulation.
MedLine Citation:
PMID:  23280073     Owner:  NLM     Status:  Publisher    
Background: The blood membrane interaction induced during hemodialysis (HD) activates the coagulation system. To prevent clotting and to maintain dialyzer patency, an anticoagulant such as tinzaparin is used. To increase patency of the dialyzers and to reduce the risk of bleeding related to anticoagulation, citrate-containing dialysate has been introduced in Europe. 
Purpose: The aim of this randomized, cross-over study was to investigate if citrate-containing dialysate was safe and efficient enough as the sole anticoagulation agent in chronic HD patients. 
Material and Methods: In this clinical setting, 23 patients on chronic hemodialysis were randomized in a cross-over design using anticoagulation either by LMWH-tinzaparin or citrate (Cit) as dialysate 
(22 completed the study). The study included paired analyses of subjective patency, ionized calcium (iCa), urea reduction rate. 
During Cit-HD, the iCa was significantly more reduced with prolonged time. The lowest iCa measured was 0.96 mmol/l. The median iCa after 210 min of HD was 1.02 for Cit-Hd and 1.16 for standard tinzaparin-HD (p = 0.001). Patency of dialyzers was estimated as clear in 14%, stripes of clotted fibers in 36%, and a red filter in 32% of HD session. The addition of approximately 40% of the patients' usual dose of tinzaparin was given to 7 of the patients as a bolus. Four Cit-HD sessions had to be interrupted prematurely due to clotting. 
Conclusion: A significant proportion of patients treated with citrate-containing dialysate need additional anticoagulation.
Bernd G Stegmayr; Per Jonsson; Dana Mahmood
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-1-2
Journal Detail:
Title:  The International journal of artificial organs     Volume:  -     ISSN:  1724-6040     ISO Abbreviation:  Int J Artif Organs     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-1-2     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802649     Medline TA:  Int J Artif Organs     Country:  -    
Other Details:
Languages:  ENG     Pagination:  0     Citation Subset:  -    
Department of Public Health and Medicine, Internal Medicine, Umeå University, Umeå - Sweden.
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