Analysis of the Effect of High-Dose Segmental Citrate Anticoagulation in High Flux Hemodialysis

Abstract

Objective: To analyze the clinical effect of high-dose citrate in segmental extracorporeal anticoagulation for high-throughput hemodialysis. Methods: The subjects included in this study were admitted to the hospital for maintenance hemodialysis treatment from January 2021 to January 2023. All patients had a high risk of bleeding and received 4% trisodium citrate anticoagulant treatment, administered at a rate of 200 mL/h before and after the dialyzer. The anticoagulant effects achieved by the patients were observed and analyzed. Results: The total number of patients who received high-dose segmented citrate extracorporeal anticoagulation dialysis treatment was 50, with each patient undergoing 100 treatments. During the treatment, 2 patients had to end the treatment early due to transmembrane pressure exceeding 30 mmHg and an increase in venous pressure exceeding 250 mmHg; the treatment times for these patients were 20 minutes and 200 minutes, respectively. The remaining patients successfully completed the 4-hour treatment. Blood pH and calcium ion concentration in the venous pot were monitored. It was observed that before dialysis, after 2 hours of dialysis, and at the end of dialysis, the blood pH of the patients remained within a relatively normal range. Although some patient levels changed after dialysis, they remained within the normal range. No adverse reactions (such as numbness of the limbs or convulsions) were observed during the anticoagulant treatment. Conclusion: Administering 4% trisodium citrate at a rate of 200 mL/h before and after the dialyzer achieves a good anticoagulant effect, maintains the patient’s blood gas levels within the normal range at the end of dialysis, and causes no adverse reactions.