"55% Heparin Reduction Using Citrate Dialysate (Citrasate®)
Robert Kossmann(1), Robin Callan(2), Suhail Ahmad(3)
1-Nephrophiles, Santa Fe, New Mexico; 2-Advanced Renal Technologies, Bellevue, Washington
3-University of Washington. Seattle, Washington
Summary & Conclusions:
- Use of citrate dialysate permitted a 55% reduction in the dose of heparin during hemodialysis
- Reduction in heparin resulted in a decrease in post-dialysis bleeding from needle site to less than 15 minutes in all 31 patients
- Heparin reduction (55%) was not associated with any clotting of dialysis circuit with Citrasate®.
- Citrasate® was associated with an increase in the dose of dialysis despite a 55% decrease in heparin
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Background and Aims:
- Systemic heparinization in hemodialysis patients increases the risk of bleeding
- Often manifesting as prolonged bleeding from access needle-sites after the removal of needles.
- Often manifesting as prolonged bleeding from access needle-sites after the removal of needles.
- Dialysate containing citrate, Citrasate® (CD) has been reported to prevent clotting of dialysis circuit )Tu et al Dialysis & Transplantation. 29: 620. 2000).
- Aim of the study was to assess whether CD would permit a safe reduction in heparin dose and would reduce bleeding episodes without increased clotting (maintaining the dose of dialysis)
Methods:
- Thirty one chronic HD patients were identified as having postdialysis bleeding for > 15 minutes from needle sites.
- Using standard acetate containing bicarbonate non-citrate dialysis (NCD) with either Optiflux NR 160 or NR 180 dialyzers.
- All patients were switched to CD (Citrasate®, Advanced Renal Technologies, Bellevue, WA, USA) without changing Qb, Qd, treatment duration or other parameters and followed for 2 months.
- After 2 months each patient's heparin dose was reduced by 33% for 3 months and, after assessing adequate dialysis, the dose was further reduced by another 33% (55% reduction from initial dose)for another 3 months.
- Dialyzer, tubings and air-traps were observed for clotting
- Patient observation was used to identify post-dialysis bleeding from needle sites (>15 minutes)
- The Adequacy of dialysis was measured by Kt/V urea.
Acknowledgement:
- The authors wish to thank the management and staff of Fresenius Medical Care, NA for their help and assistance with this study.