Regional citrate anticoagulation for hemodialysis following cardiovascular surgery

Coronary artery revascularization and cardiac valve replacement have been performed with increasing frequency over the past decade in patients maintained on chronic hemodialysis. Hemodialysis is frequently required shortly after surgery for treatment of hyperkalemia or volume overload. Use of low-dose or regional heparinization for hemodialysis may cause bleeding in patients who have recently undergone open-heart surgery. We performed 16 hemodialysis using regional citrate anticoagulation in 4 maintenance dialysis patients who had recently undergone cardiothoracic surgery. Systemic anticoagulation did not occur during any of the initial procedures, and in each patient a decrease in sanguineous chest tube drainage was observed during the initial postoperative dialysis.