#5959 CONSIDERABLE HEPARIN SAVINGS DURING 48 WEEKS OF HEMODIALYSIS WITH CITRATE-BUFFERED DIALYSIS BATH

Abstract

Abstract Background and Aims There are research data suggesting a citrate-buffered dialysis bath being superior to conventional acetate-buffered dialysis. Since Heparin may lead to bleeding complications and increased costs we focused on potential Heparin savings in a cohort of 100 dialysis patients who systematically were examined in a 48 weeks comprising timeframe using a citrate-buffered dialysis bath. Method Stable dialysis patients (n = 100, 30 females, mean age 70.7 yrs.) who were treated by high flux dialysis were switched from conventional acetate-buffered dialysis (3mmol/l acetate) to a citrate-buffered dialysis bath (0.8 mmol/l citrate, 0.3 mmol/l acetate; MTN, Neubrandenburg, Germany). After a 4 weeks run-in phase on the new dialysis bath the heparin-dosing was systematically reduced. Heparin was given as a single shot prior to the start of dialysis, the dialysate flow was set on 500 mL/min constantly. Heparin-dosing in the time course was assessed on the basis of the run-in phase. Results Average treatment time was 256 minutes per session and the average blood flow at baseline 361 mL/min and 254 minutes and 369 ml/min at the end of follow-up. The average Heparin-dosing at start of the observation period was 5450 IU/session, which could be reduced to 3909 IU/ session (71% of the starting dose, p<0.01) after the first month of treatment and was further decreased to 3147 IU/session after 24 weeks treatment (58% of the initial dose, p<0.01). In the next 24 weeks of observation no further reductions of Heparin-dosing were achieved (average Heparin dose after 48 weeks 3115 IU/session). In the week before reduction of Heparin we observed 2.2% of clotting episodes and 1.6% at week 48, respectively. Conclusion Despite a reduction of the initial heparin dose by 42% the number of clotting episodes did not increase during the 48 weeks observation period. Our data indicate that long-term treatment with a citrate-buffered dialysis bath is feasible, irrespective of considerably reduced heparin-dosing which may be beneficial for the patient but also interesting from a commercial view point. Further long-term studies are ongoing to assess clinical effects like calcification, morbidity, and mortality.