Original investigationsDialysis therapiesCitrate for long-term hemodialysis: Prospective study of 1,009 consecutive high-flux treatments in 59 patients
Section snippets
Study design and setting
This is a prospective, longitudinal, observational study of the first 1,009 citrate-anticoagulated high-flux hemodialysis treatments performed during a 2-year period at a long-term hemodialysis ward (12 places, 3 shifts) of a tertiary-care center.
Outcome measures
Primary outcome measures were the feasibility and safety (in terms of adverse events, calcium homeostasis, and electrolyte and acid-base control) of citrate anticoagulation during high-flux hemodialysis in the setting of a maintenance hemodialysis
Clinical results
One thousand five of 1,009 treatments were accomplished successfully. Citrate anticoagulation was tolerated well, and only 2 adverse events related to citrate anticoagulation were observed (0.2%). Both events were caused by handling errors at the beginning of our experience (treatments 6 and 9). One patient reported oral paresthesia when the 5-fold citrate dose was infused erroneously for 10 minutes and ionized calcium levels decreased from 2.36 mEq/L (1.18 mmol/L) to 1.56 mEq/L (0.78 mmol/L).
Discussion
We show in a large prospective study that routine use of regional citrate anticoagulation in the setting of a maintenance hemodialysis ward is practicable, efficient, and safe. One thousand five of 1,009 consecutive citrate anticoagulated high-flux hemodialysis treatments (99.6%) were accomplished successfully. Citrate-associated adverse events were extremely rare (0.2%) and were caused by handling errors in the early implementation phase (treatments 6 and 9). Perturbations of sodium and
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Originally published online as doi:10.1053/j.ajkd.2004.12.002 on January 26, 2005.