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Simple citrate anticoagulation protocol for low flux haemodialysis

BACKGROUND: For patients unable to receive heparin anticoagulation during haemodialysis, saline flushes to reduce circuit clotting are often the norm. Regional citrate anticoagulation (RCA) although effective is not used by many centres including in Singapore. We wanted to demonstrate the superiorit...

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Autores principales: Lim, Eng Kuang, Seow, Ying-ying T, Chen, Shun E, Yang, Gao, Liaw, Min Er, Isaac, Shimi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5775524/
https://www.ncbi.nlm.nih.gov/pubmed/29351783
http://dx.doi.org/10.1186/s12882-018-0811-y
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author Lim, Eng Kuang
Seow, Ying-ying T
Chen, Shun E
Yang, Gao
Liaw, Min Er
Isaac, Shimi
author_facet Lim, Eng Kuang
Seow, Ying-ying T
Chen, Shun E
Yang, Gao
Liaw, Min Er
Isaac, Shimi
author_sort Lim, Eng Kuang
collection PubMed
description BACKGROUND: For patients unable to receive heparin anticoagulation during haemodialysis, saline flushes to reduce circuit clotting are often the norm. Regional citrate anticoagulation (RCA) although effective is not used by many centres including in Singapore. We wanted to demonstrate the superiority and safety of a simple regional citrate anticoagulation regime, compared to saline flushes, for heparin-free low flux haemodialysis. METHODS: This is a prospective, open label, cross over study on 25 sequential haemodialysis sessions for inpatients receiving heparin-free haemodialysis. Patients were allocated either to regional citrate anticoagulation or standard heparin free haemodialysis and subsequently cross over to the alternate method. RCA was carried out using a protocol derived from previous studies. Assessment of anticoagulation was performed using visual inspection of clot formation in dialysis circuits and post-filter ionized calcium (iCa2+) using point-of-care Ionized calcium device at stipulated intervals. Intravenous Calcium gluconate replacement was given to patients receiving citrate adjusting the rate according to pre-filter iCa2+. Laboratory analyses of electrolytes were also assessed at the start and end of the RCA sessions. RESULTS: There were no clots in the RCA arm, with 79% (n = 19) in the saline flush arm having some clot, including 1 clotted circuit. Post-filter iCa2+ at various time points were within acceptable range. Electrolyte readings in the RCA group were all within normal limits except for 4 cases of total Calcium:iCa2+ ratio > 2.5. CONCLUSION: RCA is confirmed to be superior to saline flushes for circuit patency. We have a simple and safe protocol that can be followed for low flux haemodialysis. The study was approved by Singapore National Health Group domain-specific ethnical committee. NHG DSRB reference number 2014/01037. TRIAL REGISTRATION: Trial registration number: ISRCTN69952745 (registration date 8/11/17). 
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spelling pubmed-57755242018-01-31 Simple citrate anticoagulation protocol for low flux haemodialysis Lim, Eng Kuang Seow, Ying-ying T Chen, Shun E Yang, Gao Liaw, Min Er Isaac, Shimi BMC Nephrol Research Article BACKGROUND: For patients unable to receive heparin anticoagulation during haemodialysis, saline flushes to reduce circuit clotting are often the norm. Regional citrate anticoagulation (RCA) although effective is not used by many centres including in Singapore. We wanted to demonstrate the superiority and safety of a simple regional citrate anticoagulation regime, compared to saline flushes, for heparin-free low flux haemodialysis. METHODS: This is a prospective, open label, cross over study on 25 sequential haemodialysis sessions for inpatients receiving heparin-free haemodialysis. Patients were allocated either to regional citrate anticoagulation or standard heparin free haemodialysis and subsequently cross over to the alternate method. RCA was carried out using a protocol derived from previous studies. Assessment of anticoagulation was performed using visual inspection of clot formation in dialysis circuits and post-filter ionized calcium (iCa2+) using point-of-care Ionized calcium device at stipulated intervals. Intravenous Calcium gluconate replacement was given to patients receiving citrate adjusting the rate according to pre-filter iCa2+. Laboratory analyses of electrolytes were also assessed at the start and end of the RCA sessions. RESULTS: There were no clots in the RCA arm, with 79% (n = 19) in the saline flush arm having some clot, including 1 clotted circuit. Post-filter iCa2+ at various time points were within acceptable range. Electrolyte readings in the RCA group were all within normal limits except for 4 cases of total Calcium:iCa2+ ratio > 2.5. CONCLUSION: RCA is confirmed to be superior to saline flushes for circuit patency. We have a simple and safe protocol that can be followed for low flux haemodialysis. The study was approved by Singapore National Health Group domain-specific ethnical committee. NHG DSRB reference number 2014/01037. TRIAL REGISTRATION: Trial registration number: ISRCTN69952745 (registration date 8/11/17).  BioMed Central 2018-01-19 /pmc/articles/PMC5775524/ /pubmed/29351783 http://dx.doi.org/10.1186/s12882-018-0811-y Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Lim, Eng Kuang
Seow, Ying-ying T
Chen, Shun E
Yang, Gao
Liaw, Min Er
Isaac, Shimi
Simple citrate anticoagulation protocol for low flux haemodialysis
title Simple citrate anticoagulation protocol for low flux haemodialysis
title_full Simple citrate anticoagulation protocol for low flux haemodialysis
title_fullStr Simple citrate anticoagulation protocol for low flux haemodialysis
title_full_unstemmed Simple citrate anticoagulation protocol for low flux haemodialysis
title_short Simple citrate anticoagulation protocol for low flux haemodialysis
title_sort simple citrate anticoagulation protocol for low flux haemodialysis
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5775524/
https://www.ncbi.nlm.nih.gov/pubmed/29351783
http://dx.doi.org/10.1186/s12882-018-0811-y
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