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Citrate-containing Dialysate an Option for Chronic Dialysis Patients Unable to Receive Anticoagulants: Presented at ASN

By Maria Bishop

PHILADELPHIA, PA -- November 11, 2005 -- Citrasate, a dialysate containing sodium citrate, may provide an option for patients undergoing extended daily dialysis (EDD) who cannot take systemic anticoagulants, researchers reported here at the 38^th Annual Meeting and Scientific Exposition of the American Society of Nephrologists (ASN).

Chronic dialysis patients sometimes have contradindications to anticoagulants, such as an allergy to heparin, noted James R. Madison, DO, MS, Division of Nephrology, Renal Services Program, University of California Davis Medical Center, Sacramento, California, United States. Citrasate offers these patients an effective alternative, he added during his presentation on November 10^th.

In their retrospective cohort study, Dr. Madison and colleagues examined 59 EDD treatments using Citrasate without systemic anticoagulation in 14 intensive-care-unit patients. Treatments were ordered for 6 to 8 hours, and saline line flushes were performed at 1-hour intervals in 92% of cases.

Cases were compared to a group of matched control patients who received saline flushes alone during anticoagulant-free EDD treatments in the ICU.

Results show that patients on Citrasate with hourly saline flush every 30 to 60 minutes had significantly less clotting compared to those on saline flush alone (16% vs. 30%).

The results also show that use of Citrasate also required less frequent flushing of dialysis circuits, thus reducing nursing time.

Median ionized calcium levels in Citrasate patients remained stable at the end of dialysis. Mean arterial pressure in these patients decreased by 5 mm Hg (P = .008), with a median ultrafiltration of 2.1L (1.4 to 3.0 interquartile range). The ultrafiltration goal was not reached due to system clots in five of 59 treatments.

Treatments were terminated early in 15% of cases (9 of 59 cases were cut short by a mean of 2.0 hours), venous chamber clots were seen in all cases, and dialyzer clotting was noted in 67%.

No adverse events were noted in this study.

Dialysis access was via non-cuffed catheter in 39 cases (internal jugular location in 35) and in the remaining via tunneled catheter or arteriovenous graft.

The researchers concluded that use of a citrate-containing dialysis may be an option in the management of renal replacement therapy in the complicated, acute-care setting.


[Presentation title: Citrate-Containing Dialysate Is Well Tolerated by Patients on Extended Daily Dialysis (EDD) in the Acute-Care Setting. Abstract 621]

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