Evaluation of the application of regional citrate anticoagulation in sustained low efficiency hemodialysis

OBJECTIVE: To compare the anticoagulation effect of regional citrate and heparin in patients with sustained low-efficiency hemodialysis (SLED). METHOD: This study was conducted in the teaching hospital of Sichuan University between November 2011 and January 2013.Sixty-three patients suffering from acute kidney injury or end-stage renal diseases (ESRD) were enrolled and further randomized to 2 groups: citrate and heparin anticoagulation treatment groups in SLED. SLED was conducted by Fresenius 4008sARrTplus dialyzer for 8 hours each session, and blood flow was set at 150 ml/min. Prothrombin time (PT), activated partial thromboplastin time (APTT) and platelet (PLT) count were analyzed. RESULT: Sixty-three patients underwent 118 sessions of SLED. Among them, 59 patients (93.7%) was discharged after treatment or converted to outpatient intermittent hemodialysis, and 4 patients died of multiple organ failure during hospitalization. Compared with that in the citrate group, both PT and APTT in heparin group was significantly higher [PT: (15.5 ± 2.0) s vs (12.3 ± 2.7) s, P < 0.001; APTT: (56.0 ± 10.9) s vs (32.8 ± 6.1) s, P < 0.001;respectively] at 2 h during SLED.However, the PT and APTT levels in heparin group decreased afterwards and were similar with those in the citrate groups at 5 h during treatment. There is no difference on PLT counts between these two groups after treatment. CONCLUSION: The anticoagulation effect of regional citrate and heparin was similar in patients when receiving SLED.Regional citrate may be an alternative anticoagulant approach for the patients at high risk of bleeding who require the treatment of SLED.