An Investigation Of The Efficacy And Safety Of A Simplified Regional Citrate Anticoagulation Protocol In Heparin-free Hemodialysis

Objective:To investigate the efficacy and safety of a simplified regional citrate anticoagulation protocol(S-RCA)in heparin-free hemodialysis(HD).Methodology:From June 2016 to January 2017,42 maintenance HD(MHD)patients in our center requiring heparin-free HD due to various reasons were enrolled in this study.Among them,13 enrolled in the former term of the study were prescribed to received S-RCA based on protocol 1 and 29 enrolled in the latter term of the study receiving S-RCA based protocol 2.As in protocol 1,at the commence of HD session,15%trisodium citrate(TSC)was continuously infused into arterial line at the site pre-filter with a speed of 40ml/h;which was the same in protocol 2,except for additional infusion of 15%TSC into venous line at the venous bubble trap with the speed of lOml/h.Common dialysate composition containing calcium was used in this study and no supplement of calcium was given,which is different from the standard RCA protocol as reported by others,.The severity of filter and line clotting,unplanned ending of HD session were analyzed,as well as possible adverse reactions.Results:Totally,37 sessions of HD in 13 patients using protocol 1 and 129 sessions of HD in 29 patients using protocol 2 were observed.No adverse reaction was observed.The percentage of unplanned ending of HD was 24.3%and 1.6%in protocol 1 and 2,respectively(P<0.01).The efficacy for anticoagulation,which defined as no occurrence of severe clotting,was 89.12%in protocol 1 and 94.57%in protocol 2 for filter(P>0.05),while was 78.3%in protocol 1 and 90.7%in protocol 2 for venous bubble trap(P<0.05).There was no significant change of serum calcium before and after HD session,as revealed by blood gas analysis pre-and post-HD in protocol 2(P>0.05).Conclusion:The simplified protocols of RCA,particularly protocol 2,may be effective in heparin-free HD to prevent severe filter and venous trap clotting and guarantee completion of planned HD sessions,without any adverse reaction and impact on serum calcium.