Efficacy and tolerance of sustained low-efficiency dialysis with calcium-free citrate-containing dialysate anticoagulation

摘要

Sustained low-efficiency dialysis (SLED) is a hybrid renal replacement therapy (RRT) using intermittent haemodialysis (iHD) equipment with lower blood flow (QB) and dialysate flow (QD) combined with prolonged sessions. The popularity of SLED stems from its more efficient ultrafiltration (UF) and enhanced haemodynamic tolerance. Regional citrate anticoagulation has emerged as the preferred anticoagulation technique in continuous RRT thanks to decreased bleeding risk and increased extracorporeal circuit lifetime [1–3]. Herein we describe a modified protocol using dialysate as a source of citrate anticoagulation as citrate enters to blood compartment by diffusion from dialysate. Citrate dialysate without calcium and magnesium allows better anticoagulation, avoiding heparin use and citrate infusion [4]. It deserves to be evaluated during SLED in case of major fluid overload.