Standard Citrate Versus Sequential Citrate/Anticoagulant‐free Anticoagulation During Hemodialysis: A Randomized Trial

Abstract

In a randomized study, sequential anticoagulation for hemodialysis (citrate for the first 3.5 h, switching to 30-min anticoagulation-free hemodialysis) was compared to standard citrate anticoagulation. Fifty-two hemodialysis procedures were randomized either to sequential (n = 27) or standard citrate group (n = 25). The antithrombotic effect in the circuit was visually assessed after hemodialysis using a score from 1 (total clotting) to 5 (no clotting). The antithrombotic score for sequential versus standard group was as follows: dialyzer, 4.0 +/- 1.1 versus 4.8 +/- 0.4 (P < 0.01); arterial bubble trap, 4.0 +/- 1.2 versus 4.7 +/- 0.6 (P = 0.013); venous bubble trap, 4.0 +/- 1.3 versus 4.8 +/- 0.6 (P < 0.01). Serum citrate levels during sequential versus standard citrate anticoagulation (micromol/L) were as follows: at the beginning, 143 +/- 65 versus 148 +/- 77 (not significant [NS]); after 2 h, 317 +/- 157 versus 354 +/- 111 (NS); at the end, 125 +/- 81 versus 405 +/- 133 (P < 0.01). Sequential anticoagulation reduces the final serum citrate concentration to predialysis level. It can be a good anticoagulation strategy for patients in whom the reduction of citrate load is desired.