Abstract:

Objective To investigate the anticoagulation effect and safety of heparin⁃free，one⁃stage andtwo⁃stage citrate anticoagulation during hemodialysis with calcium⁃containing dialysate. Methods Hemodialysispatients with high risk of bleeding were randomly divided into three groups：heparin⁃free group（N⁃HEP group），one⁃stage anticoagulant group（S⁃RCA group），and two⁃stage anticoagulant citrate group（TS⁃RCA group），with atotal of 66 cases to complete the hemodialysis. The N⁃HEP groups were treated with normal saline flush pipeline，the S⁃RCA group with 4% citrate anticoagulants pumped in the front of the dialyzer and the TS⁃RCA group with 4%citrate anticoagulants pumped in the front of the dialyzer and at the venous pot as well. The three groups werecompared in terms of the hemodialysis treatment time，anticoagulant efficiency and safety. Results The treatmenttime of the S⁃RCA group and the TS⁃RCA group was both significantly longer than that of the N⁃HEP group（P＜0.05）. There was no significant difference in anticoagulant efficiency among the three groups at the hemodialysisfilter（P > 0.05）. The anticoagulation efficiency of the S⁃RCA group and the TS⁃RCA group was significantly higherthan that of the heparin⁃free group（P < 0.05），while the difference between the S⁃RCA group and TS⁃RCA groupwas not statistically significant（P > 0.05）. After hemodialysis，serum free calcium in both the S⁃RCA group andTS⁃RCA group significantly decreased compared with that before hemodialysis（P < 0.05）. Conclusions Forhemodialysis patients with high risk of bleeding，anticoagulation with citrate is superior to anticoagulation withoutheparin. It is safe and effective.

Key words: citrate, anticoagulation, hemodialysis