Proposed Topic (Most preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service II (Projects aiming to enhance clinical safety and outcomes, clinical governance / risk management)
Authors (including presenting author) :
Ho KM(1), Chan YHJ(1), Chak WL(1), Sung KMD(1)
Affiliation :
(1) Department of Medicine (Renal Unit), Queen Elizabeth Hospital
Introduction :
Unfractionated heparin (Hep) is commonly use in chronic haemodialysis (HD). However, its use is associated with potential side effects. Citrate dialysate (CD) impaired the clotting process within the dialyzer and hence has the potential to reduce the anticoagulation requirement during haemodialysis.
Objectives :
In this study, we would like to study the possibility of reducing Hep requirement in HD patients using CD and their dialysis treatment outcomes.
Methodology :
HD patients using high dose heparin for anticoagulation in QEH were recruited. Each patient would receive 10 HD sessions using conventional bicarbonate dialysate followed by 10 sessions using CD (SelectBag Citrate, citrate level of 3mEq/L). Dosage of heparin would be minimized by adjusting the dosage under study protocol based on a standardized 0-4 visual clotting scale. Total heparin consumption (THC) and HD parameters including Transmembrane Pressure (TMP), Target Therapeutic Fluid Volume Eliminated (TVFE), Blood Flow Rate (BFR) and KT/V measured by Diascan (OCM) of each HD session would be collected. Pre and post-dialysis serum biochemistry, CRP and haemoglobin level would be measured. Hemodynamic stability, time to achieve post-haemodialysis haemostasis and HD bleeding event would be monitored. Primary outcome is the change in THC with CD. Secondary outcome is the effect of CD to dialysis treatment outcome. Paired t-test and descriptive statistics were used to analyse the within-subject differences.
Result & Outcome :
Five patients fulfilling the criteria were recruited into the study, of whom 3(60%) were male and 2(40%) were female. Their ages ranged from 50 to 68 (mean 62.87.25). The treatments were well tolerated by all 5 patients. Data were available from 98 successful HD sessions. There was a statistically significant reduction in total heparin consumption using CD (mean difference: -779.28 IU, p =0.012). There were no significant within-subject differences in TMP (-6.75mmHg, p=0.170), BFR (+11.34ml/min, p=0.37), %TVFE (+1.45%, p=4.84), and OCM (-0.102, p=0.194). The mean post-HD ionized calcium level was 1.050.06 mmol/L.
Conclusion
Use of CD was well tolerated and could effectively reduce THC. There was no significant change in dialyzer function and patient’s HD adequacy. CD could be an alternative for HD patients to reduce their anticoagulant usage during HD. However, iCa were significantly lowered post HD, hence careful observation of post HD hypocalcaemia-related symptoms might be warranted.
