Abstract: Target To observe the safety and efficacy of segmented citrate anticoagulation (SCA) in high flux hemodialysis (HFHD) with calcium-containing dialysate. Methods The maintenance hemodialysis patients with high risk of bleeding were treated by SCA-HFHD. Clinical parameters were observed regularly during the treatment, including blood pressure, pulse, dialysis parameters, and blood ionized calcium levels (Ca2 + ) at different points in the dialysis pipeline. The urine reduction ratio (URR) and Kt/V were calculated, and the coagulation situation in dialyzers and tubes were recorded. The above parameters were compared between sessions with and without coagulation. Results A total of 133 SCA-HFHD sessions in 19 patients were studied. The mean effective blood volume was 205.8±22.5 ml/min, mean dialysate volume was 370.7± 105.0 ml/min, and mean volume of 4% trisodium citrate was 314.6±14.2 ml/h before dialyzer and 53.5±6.3 ml/h after dialyzer. The mean blood Ca2+ level was 0.76±0.16 mol/L at inlet point of blood line and 0.45±0.14 mmol/L at outlet point of blood line. The mean URR was 65.9%±9.8% and Kt/V was 1.38±0.31 in a session. Hemoglobin levels before and after SCA-HFHD treatments were stable (94.8±13.8 g/L vs. 94.3±12.0 g/L, t= 0.481, P=0.639). There were 80 sessions (60.2%) without coagulation. Venous pressures were significantly lower in sessions without coagulation than in sessions with coagulation (72.0 ± 37.7 mmHg vs. 91.1 ± 31.5 mmHg, t=-3.055, P=0.003). Conclusion SCA-HFHD is a safe and effective treatment for patients with high risk of bleeding.

Key words: Trisodium citrate, Anticoagulation, Hemodialysis, High-flux, Ionized calcium