WHY CITRATE ANTICOAGULATION WILL BE THE FUTURE ANTICOAGULATION IN CHRONIC HEMODIALYSIS

• Published in: International journal of artificial organs 2011-08, Vol.34 (8), p.630-630
• Main Author: Falkenhagen, D
• Format: Article
• Language: English
• Subjects: Alternative pathway
• ISSN: 0391-3988

Objectives: Cardiovascular diseases have a very high impact on mortality and morbidity of patients suffering from end-stage liver disease being under chronic hemodialysis therapy. It is well known and clinically proved that chronic and acute inflammations are processes which are responsible for cardiovascular diseases, especially related to arteriosclerosis. Especially in RDT patients treated three times a week by hemodialysis - inflammatory processes are more or less continuously activated by the use of extracorporeal circulation using materials which are responsible for activation of inflammatory processes. Methods: Citrate anticoagulation is a possibility to diminish or even completely inhibit those inflammatory processes during hemodialysis in case of using the optimal concentration of ionised calcium in the extracorporeal circuit. Using this optimal target concentration there is a possibility to inhibit the activation of the alternative pathway of the complement system. Furthermore, by complete inhibition of the activation of the coagulation system any link to other inflammatory systems like complement systems or even kinin systems are blocked. Additionally, there is also the possibility to block the release of microparticles from endothelial cells or even blood cells like platelets or white blood cells, which are also involved in inflammatory processes being responsible for genesis of arteriosclerosis. Results: By analysing relevant literature it will be shown that by blocking any kind of inflammatory processes during hemodialysis there is a real chance to diminish cardiovascular complications in RDT patients and, therefore, to decrease the mortality but also morbidity of this patients. Conclusions: Therefore, citrate anticoagulation should also be considered as a future anticoagulation method in ESRD-patients treated with hemodialysis regularly.