Non-anticoagulant factors affecting coagulation in the extracorporeal circulation circuit and the development of an individualized regional citrate anticoagulation protocol for hemodialysis: A real-world retrospective study

Objective:To investigate non-anticoagulant factors that affect blood coagulation in the extracorporeal circulation (ECC) circuit of regional citrate anticoagulation (RCA) protocol for hemodialysis (HD). Method:The clinical characteristics of patients undergoing an individualized RCA protocol for HD between February 2021 and March 2022 were collected; Coagulation scores, pressures in various parts of the ECC circuit, the incidence of coagulation, and citrate concentrations in the ECC circuit during treatment were determined, and non-anticoagulant factors affecting coagulation in the ECC circuit were analyzed. Result:The lowest clotting rate was 2.8% in patients with arteriovenous fistula in various vascular access. Patients on Fresenius dialysis had a lower rate of clotting in the cardiopulmonary bypass line than patients on other brands of dialyzer. Low-throughput dialyzers are less likely to clot than high-throughput dialyzers. There are significant differences in the incidence of coagulation among different nurses during citrate anticoagulant hemodialysis. Conclusion:In the process of citrate anticoagulant hemodialysis, non-anticoagulant factors such as coagulation status, vascular access, dialyzer selection, and operator quality will affect the anticoagulant effect.

Automated summary

The study investigated non-anticoagulant factors that affect blood coagulation in the extracorporeal circulation (ECC) circuit of regional citrate anticoagulation (RCA) protocol for hemodialysis (HD). The clinical characteristics were collected from patients undergoing individualized RCA protocol for HD, and factors such as coagulation scores, pressures in various parts of the ECC circuit, incidence of coagulation, and citrate concentrations were analyzed. The results showed that factors such as coagulation status, vascular access, dialyzer selection, and operator quality can affect the anticoagulant effect in the process of citrate anticoagulant hemodialysis.