Abstract
Regional anticogulation was successfully performed as use of Ca-free dialysate and sodium citrate infusion. Ca-free hemodialysis system is as follows; firstly, 44% sodium citrate solution containing additional 1.6% citric acid is infused at a rate of 120ml/hr from arterial drip chamber in order to reduce ionized Ca concentration; secondly, residual ionized Ca is dialyzed by Ca-free dialysate containing 10mEq/l of sodium citrate as a binder of a trace amount of ionized Ca; finally, decreased ionized Ca is corrected by infusion of 2% CaCl2 solution from venous line at a rate of 1.4 to 1.6ml/min. Although in this system, ionized Ca was not detected and Kaolin actioated whole blood clotting time (KCT) was prolonged to more than 10 minutes at the outlet of dialyzer, ionized Ca concentration and KCT of systemic blood were kept within normal limits throughout the hemodialysis procedure. Clinically, no adverse effects were observed. It is concluded that regional anticoagulation by eliaination of ionzed Ca, one of the essential factors for both blood coagulation and platelet fanction, from extracorporeal is very useful for hemodialysis patients in high risk bleeding tendency.
