2017
DOI: 10.1097/ccm.0000000000002694
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Heparin-Free Prolonged Intermittent Hemodialysis Using Calcium-Free Citrate Dialysate in Critically Ill Patients

Abstract: Dialysis anticoagulation with calcium-free citrate-containing dialysate and calcium reinjection according to ionic dialysance is an easy-to-use, efficient, and inexpensive form of heparin-free regional anticoagulation. It allows prolonged hemodialysis sessions in critically ill patients without the need to systemically monitor ionized calcium. Furthermore, sessions can be safely extended according to the hemodynamic tolerance to ensure an adequate dose of dialysis and a negative water balance, a major point in… Show more

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Cited by 24 publications
(24 citation statements)
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“…These therapies were widely applied to hemodynamically unstable adults that required inotropic support. Recently, their use in pediatric renal replacement therapy (RRT) has started to emerge . Children developing acute kidney injury (AKI) in a critical care setup usually arise secondarily and therefore, require vasopressor support and are hypotensive with poor cardiac function.…”
Section: Introductionmentioning
confidence: 99%
“…These therapies were widely applied to hemodynamically unstable adults that required inotropic support. Recently, their use in pediatric renal replacement therapy (RRT) has started to emerge . Children developing acute kidney injury (AKI) in a critical care setup usually arise secondarily and therefore, require vasopressor support and are hypotensive with poor cardiac function.…”
Section: Introductionmentioning
confidence: 99%
“…Regional anticoagulation with citrate is highly effective but requires citrate and calcium infusions and is, therefore, more complex to monitor . Citrate dialysates without calcium have also been advocated but still require a calcium infusate . Alternatively, and for many years, heparin‐free hemodialysis has consisted in periodic saline flushes to rinse the extracorporeal circuit .…”
Section: Introductionmentioning
confidence: 99%
“…2,3 Citrate dialysates without calcium have also been advocated but still require a calcium infusate. 4,5 Alternatively, and for many years, heparin-free hemodialysis has consisted in periodic saline flushes to rinse the extracorporeal circuit. 6,7 However, this technique is time-consuming for the nurses and may induce fluid overload.…”
Section: Introductionmentioning
confidence: 99%
“…[1][2][3][4] Nevertheless, heparin-free hemodialysis is often warranted as in postoperative states, in patients with bleeding diathesis, and in critically ill patients in the intensive care unit. [5][6][7][8][9] Conventionally, this is achieved through normal saline flushes, or with the application of regional citrate anticoagulation. 1,[6][7][8][9] We recently encountered a set of converging clinical scenarios in which a male patient on home hemodialysis (HHD) using an NxStage machine had to be discharged home from hospital on heparin-free HHD; despite large-volume saline flushes, he had continued to clot his extracorporeal circuits and filters with resulting inadequate HHD.…”
mentioning
confidence: 99%
“…[5][6][7][8][9] Conventionally, this is achieved through normal saline flushes, or with the application of regional citrate anticoagulation. 1,[6][7][8][9] We recently encountered a set of converging clinical scenarios in which a male patient on home hemodialysis (HHD) using an NxStage machine had to be discharged home from hospital on heparin-free HHD; despite large-volume saline flushes, he had continued to clot his extracorporeal circuits and filters with resulting inadequate HHD. The use of heparin or warfarin was contraindicated, and the patient and the caregiver (wife) were considering stopping HHD.…”
mentioning
confidence: 99%