Regional Citrate Anticoagulation for Hemodialysis in the Patient at High Risk for Bleeding

Abstract

CONVENTIONAL hemodialysis requires heparin anticoagulation to prevent clotting in the dialysis assembly. Hemodialysis of the patient who is at high risk for hemorrhage is complicated by a 10 to 30 per cent incidence of bleeding, which results from systemic anticoagulation.^{1 2 3 4 5 6 7} Alternatives to conventional heparin anticoagulation that are designed to reduce bleeding complications during hemodialysis include limited-dose heparinization,^{1 , 2} neutralization of heparin with protamine,^{2 , 3} prostacyclin infusion,^{4 , 5} and non-anticoagulant high-flow-rate hemodialysis.^{6 , 7} Although the incidence of bleeding complications has been reduced, each of these methods has its own limitations or complications.^{1 2 3 4 5 6 7} We have developed a unique method using sodium citrate as the sole anticoagulant. . . .