Biocompatibility Parameters with Standard and Increased Dose of Citrate in Hemodialysis—A Randomized Trial

Abstract

Background: The dose of citrate needed in regional citrate anticoagulation (RCA) to achieve optimal biocompatibility is unknown. We performed a randomized trial comparing two doses (ACTRN12613001340729). Methods: In 30 patients a single hemodialysis with either standard (2.7 mmol/L) or increased dose of citrate (4 mmol/L) was performed. C5a-desArg, myeloperoxidase (MPO), thrombin-antithrombin complex (TAT), and platelet factor 4 (PF4) were measured and the inner surface of the dialyzer fibers was evaluated with scanning electron microscopy (SEM). Results: A good separation of anticoagulation effect was achieved (post-filter ionized calcium 0.20 vs. 0.31 mmol/L, p < 0.05). There was no effect of citrate dose on any of the biocompatibility parameters; transient and parallel increase in PF4 after 30 min and parallel increase in TAT after 4 h were observed. There were no visually detected clotting problems within the circuit and no significant hypocalcemia in either group. SEM clotting score was excellent and comparable in both groups (p = 0.59). Conclusions: Given the excellent results in both groups, absence of between group differences and inability of the increased dose of citrate to completely blunt the small residual increase in PF4 and TAT, we conclude that the standard dose of citrate seems sufficient in RCA for chronic hemodialysis.

Immune System Dysfunction and Inflammation in Hemodialysis Patients: Two Sides of the Same Coin

“…In a recent study, Orsag tested the effect of variable doses of citrate on biocompatibility parameters in HD patients, observing that 3 mmol/L of citrate abolished platelet activation, with no changes in the clotting score of the HD circuit [40].…”

“…Pro-thrombotic status mediated by activated intrinsic and extrinsic pathways leading to pro-inflammatory effects and endothelial cell damage Platelet dysfunction with atypical activation D-dimer, β-TG TAT Anticoagulant citrate [39,40] Polyvinylpyrrolidone [37,38] Oxidative Stress…”

Terahertz Metamaterial Sensor for Sensitive Detection of Citrate Salt Solutions

“…When CSs are used as medicines, they have different functions. For instance, potassium citrate (K-citrate) can be used to prevent and treat kidney stones, to regulate uric acid and treat hypokalemia [ 5 ]; lithium citrate (Li-citrate) can be used as a mood stabilizer to treat irritability and depression [ 6 ]; ferric citrate (Fe-citrate) can reduce the level of FGF-23 and maintain the balance of calcium and phosphorus in patients with chronic kidney disease, and improve the cardiac function [ 7 ]; zinc citrate (Zn-citrate) can be used as an effective ingredient in toothpaste, which can effectively control dental plaque, and relieve gingival bleeding and inhibit the generation of dental stones [ 8 ]; calcium citrate (Ca-citrate) can be used as the calcium fortifying agent with the best absorption effect [ 9 ]; magnesium citrate (Mg-citrate) can be commonly used as a saline laxative for patients to prepare the gastrointestinal surgery, and it can also be used to treat constipation and rectal cancer [ 10 ]; however, excessive consumption of CSs may change intestinal flora and increase gastrointestinal burden, resulting in aggravating symptoms such as osteoporosis and nervous system disorders [ 11 ]. Therefore, an accurate dosage control of each CS in food and medicine is very important for human health and safety.…”

Hemostatic changes in patients undergoing hemodialysis: Differences between central venous catheters and arterio‐venous fistulas

“…Sodium citrate for local anticoagulation has no systemic anticoagulant effects and may reduce the tendency for bleeding throughout the body compared with regular heparin 25–28 . However, larger studies would be needed to confirm whether sodium citrate or other locking solutions provide evidence of safe use in hemodialysis patients, especially with regard to morbidity risks.…”

“…Third, although sample collection was performed prior to hemodialysis sessions to avoid heparin interference with the systemic circulation, there are studies in the literature showing that heparin-containing catheter blocking solution causes inadvertent systemic anticoagulation. [25][26][27][28] This process can impair the coagulation function of the entire body, which in the later stages can lead to interference between antithrombin III, thrombin and protein C activity and trigger thrombosis or bleeding. [26][27][28] Therefore, the heparin locking solution used in this study may have entered systemic circulation, influencing the results associated with platelet activation and the blood coagulation cascade found in patients who used a CVC.…”