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Regional Citrate Anticoagulation Dialysis — ESENeph MCQ

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HardHaemodialysisRegional Citrate Anticoagulation DialysisESENeph

A haemodialysis patient has active retroperitoneal bleeding but repeated circuit clotting during heparin-free treatments with saline flushes. Which escalation provides circuit anticoagulation while minimising systemic anticoagulant effect?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Use regional citrate with ionised-calcium monitoring and protocolised replacement

Explanation lettering: D = shown as C · C = shown as D

E is correct. UK haemodialysis guidance recommends omitting or minimising systemic anticoagulation when bleeding risk is increased. If high blood flow and saline-flush strategies fail, regional citrate is an option: it chelates circuit calcium and requires protocolised calcium measurement and reinfusion, adding nursing complexity while limiting systemic anticoagulation. Systemic heparin, LMWH or warfarin can worsen active bleeding, and antiplatelet therapy is neither an effective circuit substitute nor bleeding-sparing. Citrate delivery must be adapted to local expertise and the patient’s metabolic and hepatic context.

Reference: UK Kidney Association haemodialysis guideline: anticoagulation: https://guidelines.ukkidney.org/haemodialysis/rationale-for-clinical-practice-guidelines/anticoagulation/