Blood Purification

Original Paper

Regional Citrate Anticoagulation during Hemodialysis

A Simplified Procedure Using Duocart Biofiltration

Ridel C.a · Mercadal L.a · Béné B.c · Hamani A.a · Deray G.a · Petitclerc T.a, b

Author affiliations

Departments of aNephrology and bBiophysics, Hôpital de la Pitié, Paris, and cHospal R&D Int., Lyon, France

Keywords: BiofiltrationCitrate anticoagulationHemodialysisIonic dialysance

Related Articles for ""
Blood Purif 2005;23:473–480
https://doi.org/10.1159/000089652

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Article / Publication Details

First-Page Preview
Abstract of Original Paper

Published online: December 19, 2005
Issue release date: December 2005

Number of Print Pages: 8
Number of Figures: 2
Number of Tables: 4

ISSN: 0253-5068 (Print)
eISSN: 1421-9735 (Online)

For additional information: https://www.karger.com/BPU

Abstract

Background: Regional citrate anticoagulation during hemodialysis is promising, but its clinical implementation is routinely cumbersome because a continuous adjustment of calcium infusion at the dialyzer outlet is needed. Duocart biofiltration (DCB) is a new hemodialysis method using a calcium and magnesium-free dialysate containing only sodium chloride and bicarbonate combined with the infusion into the venous line of a solution containing the ionic complement (K, Ca, Mg) and glucose. Since the dialysate is calcium- and magnesium-free and infusion rate of the solution containing calcium is automatically determined by the dialysis delivery system according to the on-line measured value of ionic dialysance, DCB seems a technique especially suitable for citrate anticoagulation procedure. Methods: Thirty DCB sessions were performed in 10 patients with increased risk of bleeding. A commercially available mixture of trisodium citrate, citric acid and glucose was infused into the arterial line at a rate equal to 3% of dialyzer blood flow. The ionic complement (K: 48 mM, Ca: 42 mM, Mg: 14 mM, glucose: 110 mM) was infused at a rate equal to 1/24 ionic dialysance value automatically determined each 15 min by the dialysis monitor. DCB sessions were compared to 21 conventional bicarbonate hemodialysis (BHD) sessions with low-molecular-weight heparin anticoagulation. Results: Whole blood activated clotting time (WBACT) measured in the venous line (before infusion of ionic complement) was 200% of the WBACT value in the arterial line. Clotting and citrate-related adverse events were not observed. Postdialysis compression time of the arteriovenous access is significantly (p < 0.001) shorter after DCB sessions (3.9 ± 1.1 min) compared with BHD sessions (8.7 ± 4.6 min). Conclusion: Citrate anticoagulation during Duocart biofiltration is effective, safe and suitable for routine use because calcium infusion rate is automatically adjusted without the need of monitoring degree of anticoagulation and level of ionized calcium.

© 2005 S. Karger AG, Basel



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Article / Publication Details

First-Page Preview
Abstract of Original Paper

Published online: December 19, 2005
Issue release date: December 2005

Number of Print Pages: 8
Number of Figures: 2
Number of Tables: 4

ISSN: 0253-5068 (Print)
eISSN: 1421-9735 (Online)

For additional information: https://www.karger.com/BPU

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2005, Vol.23, No. 6

December 2005

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