Simplified citrate anticoagulation for high-flux hemodialysis

Safety and Efficacy of Low Molecular Weight Heparins for Hemodialysis in Patients with End-Stage Renal Failure

“…All studies administered LMWH as a bolus injection, most into the arterial side of the dialyzer; six of the seven dalteparin studies followed the LMWH bolus with an infusion. The comparison anticoagulant was UFH in 11 studies (11,28 -33,35,36,39,40), a different LMWH in three studies (38,42,43), citrate in two studies (34,37), and danaparoid in one study (41). UFH was administered in all studies as a bolus followed by continuous infusion, either in fixed or weightadjusted doses.…”

“…The duration of follow-up was variable, ranging from assessment after a single dialysis with LMWH (37,41,42) to repeated dialyses and assessments up to 36 mo (39). Losses to follow-up were considerable; of the 645 patients who were included in the systematic review, 562 had complete data and 83 (14.8%) were lost to follow-up.…”

“…Six studies evaluated other anticoagulants (34,37,38,(41)(42)(43). Two studies that used citrate showed a trend toward lower filter clotting scores with citrate compared with dalteparin (0.31 Ϯ 0.70 versus 0.56 Ϯ 0.89) (37) and similar frequencies of clotting of the dialysis circuit with nadroparin compared with citrate (34).…”

Renal replacement therapy review

“…Low concentration citrate protocols have been developed to prevent these complications 137 as have protocols for other modalities, such as high-flux hemodialysis and SLED. [138][139][140] In patients with liver disease, citrate may accumulate if citrate infusion is greater than total clearance (filter and liver combined), and this complication may have significant effects in pediatric patients who often experience hypotension with hypocalcaemia. Hypocalcaemic Citrate Toxicity (HCCT) occurred in up to 17% of pediatric CRRT treatments without increased mortality risk.…”

Heparin-Coated Hemodialyzers –The Holy Grail for Patients at Risk of Bleeding?

“…This can cause serious complications in patients with a high risk of bleeding. Regional and low-dose heparinization HD (LDH-HD), the use of prostacyclin, regional citrate HD (RC-HD) anticoagulation [1][2][3], and high-flow-rate HD without anticoagulation (hemofiltration; HF) [4] have been shown to reduce bleeding complications. Each of these methods, however, is characterized by its own technical difficulties, limitations, or complications.…”