Abstract: Purpose To assess the efficacy and safety of regional citrate anticoagulation (RCA) with routine dialysate containing calcium in hemodialysis patients. Methods Sixty-three hemodialysis patients at high risk of bleeding were randomly divided into two groups: RCA group (30 patients, 87 dialysis sessions) and heparin-free group (33 patients, 68 dialysis sessions). In RCA group, electrolyte concentrations were adjusted on-line, and 4% sodium citrate was infused into the arterial line and vein line in the dialyzer. Kt/V, function of the coagulation system, acid-base and electrolyte were monitored pre- and post- hemodialysis. The vital signs of the patients during hemodialysis, dialyzer clotting and bleeding episodes were recorded. Results ①Kt/V was significantly higher and the mean treatment time was significantly longer in RCA group than in heparin-free group (1.2±0.3 vs. 0.9±0.2, t=-3.257, P=0.002 for Kt/V; 4.0±0.0 h vs. 3.1±0.5 h, t=5.177, P＜0.001 for treatment time). ②Clotting in dialyzer occurred more frequently in heparin-free group than in RCA group (P＜0.001). ③In RCA group, there were no significant differences in the function of the coagulation system and ionized calcium before and after the hemodialysis (t=1.708, P=0.097). pH (t=-4.590, P＜0.001), Na+ (t=-2.431, P=0.021) and HCO3- (t=-4.630, P＜0.001) increased after the hemodialysis but remained in the normal ranges. ④Vital signs were stable and no bleeding episodes were found in both groups. Conclusions It is feasible to use RCA with routine dialysate containing calcium for hemodialysis patients at high risk of bleeding by adjusting electrolyte concentrations on-line and infusing sodium citrate into the arterial line before dialyzer and vein dropper. Complications can be prevented by close monitoring of arterial blood gas and electrolytes.

Key words: Regional citrate anticoagulation, Hemodialysis, Dialysate