Key result
An increased dose of citrate (4 mmol/L) versus standard dose (2.7 mmol/L) during hemodialysis did not significantly improve biocompatibility parameters or SEM clotting scores (p=0.59).
Why the study?
The dose of citrate needed in regional citrate anticoagulation to achieve optimal biocompatibility during hemodialysis is unknown.
Does an increased dose of citrate (4 mmol/L) improve biocompatibility parameters compared to a standard dose (2.7 mmol/L) in patients undergoing hemodialysis?
RCT (n=30)
Does an increased dose of citrate (4 mmol/L) improve biocompatibility parameters compared to a standard dose (2.7 mmol/L) in patients undergoing hemodialysis?
A standard dose of citrate (2.7 mmol/L) is sufficient for regional citrate anticoagulation in chronic hemodialysis, as an increased dose (4 mmol/L) does not further improve biocompatibility parameters.
Answers are grounded in this paper and cite their sources.
Standard citrate dosing suffices for hemodialysis anticoagulation; confirms no biocompatibility gain from escalation in this RCT.
Background: The dose of citrate needed in regional citrate anticoagulation (RCA) to achieve optimal biocompatibility is unknown. We performed a randomized trial comparing two doses (ACTRN12613001340729). Methods: In 30 patients a single hemodialysis with either standard (2.7 mmol/L) or increased dose of citrate (4 mmol/L) was performed. C5a-desArg, myeloperoxidase (MPO), thrombin-antithrombin complex (TAT), and platelet factor 4 (PF4) were measured and the inner surface of the dialyzer fibers was evaluated with scanning electron microscopy (SEM). Results: A good separation of anticoagulation effect was achieved (post-filter ionized calcium 0.20 vs. 0.31 mmol/L, p < 0.05). There was no effect of citrate dose on any of the biocompatibility parameters; transient and parallel increase in PF4 after 30 min and parallel increase in TAT after 4 h were observed. There were no visually detected clotting problems within the circuit and no significant hypocalcemia in either group. SEM clotting score was excellent and comparable in both groups (p = 0.59). Conclusions: Given the excellent results in both groups, absence of between group differences and inability of the increased dose of citrate to completely blunt the small residual increase in PF4 and TAT, we conclude that the standard dose of citrate seems sufficient in RCA for chronic hemodialysis.
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Orsag et al. (2021) conducted an RCT in Hemodialysis (n=30). Citrate vs. Standard dose of citrate (2.7 mmol/L) was evaluated on Biocompatibility parameters and scanning electron microscopy (SEM) clotting score (p=0.59). An increased dose of citrate (4 mmol/L) versus standard dose (2.7 mmol/L) during hemodialysis did not significantly improve biocompatibility parameters or SEM clotting scores (p=0.59).
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