#2243 The experience from the use of citric acid blood purification solution (CD) with l-ascorbic acid (Vitamin-C) in patients under HD

Abstract

Abstract Background and Aims The use of CD offers anticoagulation with a reduced dose of heparin while the use of L-Ascorbic acid offers better management of the patients' anemia. The purpose of the study is to record the experience of using CD solution with Vitamin-C in patients with ESRD under HD Method 45 patients with ESRD under HD (40 new recruits) with an average weight of 75 kgrs received CD solution with vitamin-C (2 g/lt) for a period of 12 months. All changes in heparin dose as well as patients' anemia profile (Hb, Hct, ferritin, TSAT, rhEPO dose) were recorded. Results The initial cumulative heparin dose of 1818 ± 659.28 iu (24 iu/kgrBW) was progressively increased to 2677.41 ± 1053.15 iu (36 iu/kgrBW) at 6 months and to 3323.52 ± 1467.79 iu (44 iu /kgr/GB) at 12 months. With no observed thrombotic events or bleeding tendency, the dose of heparin used was significantly lower than the recommended doses with the classical solution (loading dose 30-50 IU/kgBW and then 10 IU/kgBW/hour). Patients' Hb and Hct progressively increased significantly (10.63 ± 1.55 start-11.79 ± 0.91 end, p < 0.05, 32.25 ± 4.45 start-36.5 ± 2, 92 end, p < 0.05) with constant weekly erythropoietin dose (14000 ± 9500 iu start-14000 ± 10000 iu end, p = NS) and stable ferritin levels (526.73 ± 498.72 iu start-690.44 ± 470.32 iu end, p = NS). The above observation was combined with a significant reduction in monthly iron administration (from 700 mg monthly initially to 200 mg monthly after one year). Conclusion Our findings suggest that the use of CD solution and vitamin C compared to the classic one offers anticoagulation with a significant reduction in the dose of heparin used, while simultaneously increasing hemoglobin with a fixed dose of erythropoietin and reduced iron administration.