Regional Citrate Anticoagulation for Intermittent Hemodialysis in Dogs.

Francey, Thierry; Schweighauser, Ariane (2018). Regional Citrate Anticoagulation for Intermittent Hemodialysis in Dogs. Journal of veterinary internal medicine, 32(1), pp. 147-156. Wiley-Blackwell 10.1111/jvim.14867

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BACKGROUND The traditional systemic heparinization used for anticoagulation in extracorporeal therapies may cause fatal complications in animals at risk of bleeding. HYPOTHESIS/OBJECTIVES To develop and validate a protocol of regional citrate anticoagulation (RCA) for intermittent hemodialysis in dogs. ANIMALS A total of 172 dogs treated with hemodialysis for acute kidney injury. METHODS In vitro titration was performed, adding trisodium citrate and calcium chloride to heparinized canine blood. A tentative protocol was used first in 66 treatments with additional heparinization and subsequently in 518 heparin-free treatments. Safety and adequacy of RCA were assessed based on clinical and laboratory monitoring, dialyzer pressure gradient, treatment completion, and visual scoring of the extracorporeal circuit. RESULTS Addition of 1 mmol/L citrate to heparinized blood decreased the ionized calcium concentration by 0.23 mmol/L (95% confidence interval [CI], 0.16-0.30) and 1 mmol/L calcium increased it by 0.62 mmol/L (95% CI, 0.45-0.79). Heparin-free treatments were initiated with infusion of trisodium citrate (102 mmol/L) at 2.55 mmol/L blood and calcium chloride (340 mmol/L) at 0.85 mmol/L. Citrate and calcium administrations were adjusted in 27 and 34% of the treatments, respectively. Overall, anticoagulation was satisfactory in 92% of the treatments, with expected azotemia reduction in 95% (urea) and 86% (creatinine), stable dialyzer pressure gradient in 82%, and clean extracorporeal circuits in 92% of the treatments. Eighteen treatments (3.5%) were discontinued prematurely, 9 because of clotting and 9 for reasons unrelated to the RCA procedure. CONCLUSIONS AND CLINICAL IMPORTANCE Regional citrate anticoagulation allows safe and efficient heparin-free hemodialysis in dogs at risk of bleeding.

Item Type:

Journal Article (Original Article)

Division/Institute:

05 Veterinary Medicine > Department of Clinical Veterinary Medicine (DKV) > Small Animal Clinic
05 Veterinary Medicine > Research Foci > Host-Pathogen Interaction
05 Veterinary Medicine > Department of Clinical Veterinary Medicine (DKV)
05 Veterinary Medicine > Department of Clinical Veterinary Medicine (DKV) > Small Animal Clinic > Small Animal Clinic, Internal Medicine

UniBE Contributor:

Francey, Thierry and Schweighauser, Ariane

Subjects:

600 Technology > 630 Agriculture
600 Technology > 610 Medicine & health

ISSN:

0891-6640

Publisher:

Wiley-Blackwell

Language:

English

Submitter:

Thierry Francey-Spicher

Date Deposited:

12 Apr 2018 12:17

Last Modified:

12 Apr 2018 12:17

Publisher DOI:

10.1111/jvim.14867

PubMed ID:

29171099

Uncontrolled Keywords:

Acute kidney injury Bleeding Coagulation Extracorporeal blood purification

BORIS DOI:

10.7892/boris.108549

URI:

https://boris.unibe.ch/id/eprint/108549

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