Regional citrate dialysis results in a small negative calcium flux

Oliver Williams, Richard Singer, Giles Walters, Girish Talaulikar

    Research output: Contribution to journalLiterature review

    Abstract

    Aim: To assess the safety, efficacy and calcium flux of regional citrate anticoagulation. Background: Standard haemodialysis requires anticoagulation, usually with heparin, to prevent clotting of the circuit. Heparin increases bleeding risk as it acts systemically, whereas citrate can provide anticoagulation limited to the dialysis circuit. Calcium replacement is necessary to maintain a normal systemic ionized calcium when citrate is used; however, there is limited data on how this affects overall calcium flux during dialysis. Methods: Dialysis was performed using calcium-free dialysate. The initial pre-dialyzer citrate, and post-dialyzer calcium infusion rate was calculated as a fraction of the prescribed dialyzer blood flow. Subsequent dose adjustments used an algorithm based on post dialyzer and systemic ionized calcium. Net calcium flux was determined by direct measurement of calcium in a complete dialysate effluent collection, less total calcium infused. Results: Over 176 dialysis sessions there was a single clotted circuit and 220 systemic ionized calcium measurements; of these 195 were within the normal range. There was one episode of severe (but asymptomatic) hypocalcaemia, which occurred in a patient that had developed unrecognized acute liver dysfunction. The mean calcium flux, assessed in 4 patients over a total of 12 dialysis sessions, was a loss of 8.3 mmol/session (range 3.7 to 12.1 mmol/session). This is equivalent to a calcium loss of 2.1 mmol/hour of dialysis (range 0.9 to 3.0 mmol/hr). Spent dialysate contained 7097% of the infused citrate mass. Conclusion: Regional citrate dialysis can be safely performed using a flexible blood fl ow prescription. The effects of a negative calcium flux with this therapy are unlikely to be deleterious, as the losses are similar to daily urinary losses in healthy non-dialysis patients.
    Original languageEnglish
    Pages (from-to)36-36
    JournalNephrology
    Volume17
    Issue numberS1
    Publication statusPublished - 2012

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