Citrate Anticoagulation in Hemodialysis

In hemodialysis, anticoagulation is necessary due to the risk of blood clotting when blood contacts artificial surfaces. Unfractionated heparin is commonly used in the U.S. but poses risks such as increased bleeding, particularly in patients with end-stage renal disease or those with additional bleeding risks. Heparin can also cause rare but serious complications like heparin-induced thrombocytopenia (HIT) type II. Alternatives like intermittent saline flushes and other anticoagulants exist but have limitations, such as labor intensity and incomplete clot prevention. Technological advances may reduce thrombogenicity, but anticoagulation remains essential.