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Modified regional citrate anticoagulation is optimal for hemodialysis in patients at high risk of bleeding: a prospective randomized study of three anticoagulation strategies.


ABSTRACT: BACKGROUND:Recommended regular saline flushing presents clinical ineffectiveness for hemodialysis (HD) patients at high risk of bleeding with heparin contraindication. Regional citrate anticoagulation (RCA) has previously been used with a Ca2+ containing dialysate with prefiltered citrate in one arm (RCA-one). However, anticoagulation is not always achievable and up to 40% results in serious clotting in the venous expansion chamber. In this study, we have transferred one-quarter of the TSC from the prefiltered to the post filter based on RCA-one, which we have called RCA-two. The objective of this study was to compare the efficacy and safety of RCA-two with either saline flushing or RCA-one in HD patients with a high bleeding risk. METHOD:In this investigator-initiated, multicenter, controlled, prospective, randomized clinical trial, 52 HD patients (77 sessions) were randomized to the RCA-2 and RCA-one group in part one of the trial, and 45 patients (64 sessions) were randomized to the RCA-2 and saline group in part two of the trial. Serious clotting events, adverse events and blood analyses were recorded. RESULTS:Serious clotting events in the RCA-two group were significantly lower compared with the RCA-one and saline group (7.89% vs. 30.77%, P?=?0.011; 3.03% vs. 54.84%, P??0.05. CONCLUSIONS:Our data demonstrated that the modified anticoagulation protocol was more effective and feasible during hemodialysis therapy for patients at high risk of bleeding. TRIAL REGISTRATION:GDREC, GDREC2017250H. Registered February 2, 2018; retrospectively registered.

SUBMITTER: Lin T 

PROVIDER: S-EPMC6924029 | biostudies-literature | 2019 Dec

REPOSITORIES: biostudies-literature

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Modified regional citrate anticoagulation is optimal for hemodialysis in patients at high risk of bleeding: a prospective randomized study of three anticoagulation strategies.

Lin Ting T   Song Li L   Huang Renwei R   Huang Ying Y   Tang Shuifu S   Lin Qizhan Q   Zhang Ying Y   Wu Xingbo X   Liang Hui H   Wu Yuchi Y   Chen Yuanhan Y   Liang Huaban H   Ma Jianchao J   Feng Zhonglin Z   Li Zhuo Z   Xu Lixia L   Fu Xia X   Ye Zhiming Z   Liu Shuangxin S   Liang Xinling X  

BMC nephrology 20191219 1


<h4>Background</h4>Recommended regular saline flushing presents clinical ineffectiveness for hemodialysis (HD) patients at high risk of bleeding with heparin contraindication. Regional citrate anticoagulation (RCA) has previously been used with a Ca<sup>2+</sup> containing dialysate with prefiltered citrate in one arm (RCA-one). However, anticoagulation is not always achievable and up to 40% results in serious clotting in the venous expansion chamber. In this study, we have transferred one-quart  ...[more]

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