P1069COMPARISON OF BIOCOMPATIBILITY OF REGULAR AND INCREASED DOSE OF CITRATE IN CHRONIC HEMODIALYSIS - PRELIMINARY RESULTS OF A RANDOMIZED TRIAL

Abstract Background and Aims The dose of citrate that is needed in regional citrate anticoagulation (RCA) to achieve optimal biocompatibility of the extracorporeal circuit is not known. Insufficient biocompatibility is related with increased inflammation and oxidative stress and therefore higher risk for cardiovascular events, as well as decreased dialysis dose. Biocompatibility is multifaceted and includes activation of coagulation and complement cascades, as well as degranulation of leukocyte and platelets. We performed a randomized control trial (ACTRN12613001340729) to compare regular and increased dose of citrate in RCA. Method 30 chronic hemodialysis patients were randomly assigned to a single hemodialysis session with RCA using either regular (2.7 mmol/l) or increased dose of citrate (4.0 mmol/l). Markers of activation of complement system (C5a), activation of hemostasis (thrombin – antitrombin complex (TAT)), activation of platelets (platelet factor 4 (PF4)) and activation of leukocyte (myeloperoxidase (MPO)) were taken at the beginning (time 0), after 30 minutes (arterial line) and after 4 hours (arterial and venous line) of dialysis. Results were corrected for changes in hematocrit, and compared between groups using T test. Results There was no significant difference in any of the measured biocompatibility parameters between the two citrate dose groups at any of the time points. We have observed a significant, but transient increase in PF4 after 30 minutes (28 +/- 17 to 47 +/-29 IU/mL vs. 30 +/-17 to 54 +/- 33 IU/mL, p<0.05 for both groups), which was parallel in both groups (p=0.76 for between group comparison). No significant changes in TAT, MPO or C5a were observed during dialysis. There were no clotting problems or significant hypocalcemia observed in either group. Conclusion Given the absence of significant increase in the majority of biocompatibility parameters at the standard dose of citrate and absence of blunting of PF4 increase by the higher dose of citrate, the standard dose of citrate (2.7 mmol/l) seems sufficient in RCA for chronic hemodialysis.