Nephrol Dial Transplant (1993) 8: 1228-1233
© 1993 European Renal Association-European Dialysis and Transplant Association
research-article
Citrate versus heparin anticoagulation in chronic haernodialysis patients
1Nephrology Unit, Free University Hospital Amsterdam, The Netherland 2Department of Haematology, Free University Hospital Amsterdam, The Netherland 3Laboratory for Clinical Chemistry, Free University Hospital Amsterdam, The Netherland
Correspondence and offprint requests to: Correspondence and offprint requests to: Dr MJFM Janssen. Nephrology Unit. Academic Hospital. Free University. De Boelelaan 1117. 1081 HV Amsterdam. The Netherlands
Anticoagulation with citrate at a rate of 0.68 mM/min in combination with a calcium and magnesium-free dialysate and i.v. supplementation of calcium and magnesium at rates of 0.18 mM/min and 0.08 mM/min respectively, was compared with lowdose heparin. The heparin dose was a loading dose of 2500 IU and a sustaining infusion of 750–1250 IU/h; or a loading dose of 1250 IU and a sustaining infusion of 500–750 IU–h until I h before the end of the dialysis if the patlent was taking concomitantly coumarin anticoagulation for a Goretex shunt. Six chronic haemodialysis patients changed from heparin to citrate anticoagulation because they reported bleeding between dialyses. Heparin, after 2 h dialysis, induced a significant 10% prolongation of each patient's wholeblood activated clotting tlme (WBACT) as compared to the predialysis value: while the WBACT at the dialyser outlet was less than 3% prolonged as compared to the patient's WBACT. However, after 2 h cltratc the patient's WBACT was not prolonged but the WBACT at the dialyser outlet was 20–100°A longer, indicating a better anticoagulation of the extracorporeal system without systemic effects. With heparin the shunt pressure time (SPT). i.e. the time needed to stop bleeding from the puncture sites of the Goretex shunts. was 12 of 28 tlrnes 20 niln or more Citrate reduced these episodes by 75%.
Thus citrate should be considered for chronic haemodialysis patients who are at risk of bleeding because of the concomitant use of anticoagulants. Other patients who could benefit from cltrate are those with premorbid vascular abnormalities such as intestinal arterlovenous malforniations. diabetic retinopathy malignant hypertension or adult polycystic kidney disease. Claims that cltrate gave improved biocompatibility. 1.e. less leukopenia or thrombocytopenia. were not confirmed. lndications that citrate caused better dialysis efficiency were found. but should be confirmed In a greater number of patients.
Keywords: heparin citrate; whole-blood activated
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