Regional anticoagulation with calcium-free dialysate containing citrate in chronic haemodialysis patients

The intermittent haemodialysis technique requires extracorporeal circuit anticoagulation to prevent clotting while minimizing the risk of bleeding complications. Heparin is currently the most commonly used anticoagulant, with a wide patient-to-patient variability. A chronic dialysis patient is likely to present periodic higher risk of bleeding requiring a temporary adjustment of the anticoagulation. Some patients have permanently high bleeding risk that necessitates an alternative method of anticoagulation. The usual regional citrate anticoagulation (RCA) uses an acid-citrate-dextrose solution containing trisodium citrate and citric acid infused into the arterial line with a calcium-free dialysate [1, 2]. This RCA technique requires calcium reinfusion after the filter and close monitoring of the systemic calcium to avoid hypocalcaemia. This generates a nurse workload not applicable in a chronic dialysis unit. A modified regional anticoagulation (RA) procedure has been developed without citrate infusion and calcium monitoring based on a calcium-free dialysate containing a small amount...