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.

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5 Citations in Web of Science ®
6 Citations in Scopus

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