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

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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. . . .