utility of citrate dialysis in patients with contraindication for heparin in a limited-resource setting

Background: hemodialysis among critical care patients with acute kidney injury (aki) is challenging, especially if heparin is contraindicated. objectives: this study assessed the utility of citrate dialysis for such patients in a limited-resource setting. methods: in this prospective study, patients were divided into group a (heparin-free saline flush dialysis), group b (heparin-free citrate dialysis without flushing), and group c (heparin-free citrate dialysis with flushing). the subjects underwent completed sustained low-efficiency daily dialysis (blood flow = 150 ml/minute, dialysate = 300 ml/minute) or intermittent hemodialysis (blood flow = 250 ml/minute, dialysate flow = 500 ml/minute). statistical tests using spss software (version 26) were used to determine safety and effectiveness differences. results: among 25 patients studied with multiple hemodialysis sessions, blood flow and dialysate flow were observed to be better in heparin-free citrate dialysis with flushing. there were further advantages of lesser dialyzer clotting and more reuse of dialyzers. metabolic differences were insignificant. heparin-free citrate dialysis with or without flushing was equally effective and safe, compared to heparin-free saline flush dialysis, in patients with or without liver impairment. conclusions: citrate dialysis is observed to be a safe and effective alternative to heparin-free saline flushing dialysis in intensive care unit patients with aki. more such studies are required in limited-resource settings to utilize citrate dialysis in patients with heparin contraindication.