Citrate anticoagulant hemodialysate in renal failure patients at high risk of bleeding

Objective:  The aim of this study was to observe the anticoagulant effect of the new type of citrate anticoagulant hemodialysate in renal failure patients at high risk of bleeding. Methods: 57 patients at high risk of bleeding were given hemodialysis for 4 hours and were divided into 3 groups according to hemodialysis procedures: Group 1 was saline‐flush hemodialysed with bicarbonate hemodialysate. Group 2 was hemodialysed with citrate hemodialysate and with no anticoagulant. Group 3 was hemodialysed with bicarbonate hemodialysate and with nadroparin calcium (a low molecular weight heparin, LMWH) as anticoagulant. Bleeding complication, coagulation of extracorporeal circuit, venous blood pressure, heart rate, QTC, activated coagulation time (ACT), ionized‐calcium (iCa++), total calcium and pH, , Na+, K+, Cl−, BUN, Cr, GPT, GST, TBIL, DBIL, as well as the blood cell counts were monitored during hemodialysis, and a scanning electron microscopic (SEM) analysis was used to investigate the morphology of thrombus formation and cellular aggregation on the interior surface of hemodialysis membranes. Results: During the hemodialysis in Group 1, venous blood pressure increased continuously, resulting in the failure of hemodialysis for 4 out of 19 patients. Hemodialysis for 4 hours in Group 2 were all successfully fulfilled. No bleeding episodes occurred. No severe clotting of dialyzers and blood accesses was observed. ACT was extended and iCa++ decreased obviously in the venous line, but ACT and iCa++ in vivo were normal. pH, tended to increase but not to metabolic alkalosis levels. Na+, K+, Cl−, GPT, GST, TBIL, DBIL, as well as the counts of blood cells were all within the normal range. There was no severe thrombus observed by SEM in the hollow fibers. In Group 3, severe bleeding complication happened to 3 out of 19 patients, and one of them died. ACT was extended obviously at the arterial end. Conclusions: The citrate anticoagulant hemodialysate was proved to be practical, safe and effective. So it is indicated for patients with an active or recently active bleeding focus.