Abstract
The ideal extracorporeal circuit for kidney replacement therapy (CKRT) would have no systemic anticoagulation. However, this approach runs the risk of extracorporeal circuit loss or partial loss of dialyzer fibers. Regional citrate anticoagulation provides anticoagulation of the circuit owing to citrate chelating calcium1,2 but is not usually used with hemodialysis (HD) because of difficulties in implementing it in clinical practice. Regional citrate anticoagulation requires rigorous monitoring of ionized calcium levels,3 which leads to increased workload for nurses (frequent modulation of calcium infusion rate is needed to ensure the patient is not exposed to dangerous hypocalcemia) and increases costs significantly related to calcium measurement and replacement infusion supply.
Highlights
To the Editor: The ideal extracorporeal circuit for kidney replacement therapy (CKRT) would have no systemic anticoagulation
Calcium dialysate concentration was increased in increments of 0.25 mmol/L using a standard hemodialysis additive (Baxter Corporation)
Citrate was infused into the heparin infusion port at 200 mL/h and ultrafiltration rate was set at 180 mL/h to account for citrate infusion
Summary
To the Editor: The ideal extracorporeal circuit for kidney replacement therapy (CKRT) would have no systemic anticoagulation. Dialysis was performed using a Fresenius 5008 machine (Fresenius Medical Care) with online-generated ultrapure dialysate in hemodiafiltration post-dilution mode. Calcium dialysate concentration was increased in increments of 0.25 mmol/L using a standard hemodialysis additive (Baxter Corporation).
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