Regional citrate anticoagulation for single-needle hemodialysis: a prospective clinical study.

AIM: Regional citrate anticoagulation protocol for single-needle hemodialysis was tested prospectively for safety and efficacy.

METHODS

15 chronic dialysis patients at risk of bleeding were included. 4% trisodium citrate (200 ml/h), calcium-free dialysate and 1 mol/l calcium chloride (7 ml/h) were used. After dialysis the antithrombotic effect in the circuit was assessed visually (grade 5, no clotting, to 1, total occlusion) and serum citrate was measured.

RESULTS

Of 32 dialyses performed, 94% were uneventful and in 2 cases (6%) there was severe (ionized calcium < or = 0.8 mmol/l) but asymptomatic hypocalcemia. Mean anticoagulation score after dialysis was 4.8 +/- 0.7 for the arterial bubble trap, 4.6 +/- 0.8 for the dialyzer and 4.8 +/- 0.7 for the venous bubble trap. Serum citrate after dialysis was 158 +/- 60 micromol/l.

CONCLUSION

Regional citrate anticoagulation in single-needle dialysis is safe and efficient.