How does citrate anticoagulation work?

Calcium (factor IV) is an essential substrate for all 3 clotting pathways Citrate is added to blood prior to the filter in the form of trisodium citrate: Chelates calcium forming a complex Prevents the involvement of calcium in the clotting cascade Regional...

What are the complications of citrate anticoagulation?

Hypocalcaemia – due to chelation Hypomagnesaemia – Mg2+ is also chelated Hypernatraemia – high sodium load in hyperosmolar trisodium citrate Metabolic alkalosis – citrate is metabolised to bicarbonate Metabolic acidosis (RAGMA) – caused by the...

How can filter life be extended if no anticoagulation is used?

From KDIGO Guidance: Good vascular access allowing high blood flows to be reliably achieved Reducing blood viscosity through the filter Predilution fluids Treatments that involve diffusion as opposed to ultrafiltration Reducing blood-air contact in the bubble trap...