{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T23:39:53Z","timestamp":1778542793182,"version":"3.51.4"},"reference-count":38,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2024,5,8]],"date-time":"2024-05-08T00:00:00Z","timestamp":1715126400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Artificial Organs"],"published-print":{"date-parts":[[2024,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Regional anticoagulation in hemodialysis avoids the use of heparin, which is responsible for both hemorrhagic and non\u2010hemorrhagic complications. Typically, blood is decalcified by injecting citrate into the arterial line of the extracorporeal circuit. Calcium\u2010free dialysate improves anticoagulation efficacy but requires injection of a calcium\u2010containing solution into the venous line and strict monitoring of blood calcium levels. Recent improvements have made regional anticoagulation with calcium\u2010free dialysate safer and easier.<\/jats:p><\/jats:sec><jats:sec><jats:title>Observations<\/jats:title><jats:p>(1) Adjusting the calcium injection rate to ionic dialysance avoids the risk of dyscalcemia, thus making unnecessary the monitoring of blood calcium levels. This adjustment could be carried out automatically by the hemodialysis monitor. (2) As calcium\u2010free dialysate reduces the amount of citrate required, this can be supplied by dialysate obtained from currently available concentrates containing citric acid. This avoids the need for citrate injection and the risk of citrate overload. (3) Calcium\u2010free dialysate no longer needs the dialysate acidification required for avoiding calcium carbonate precipitation in bicarbonate\u2010containing dialysate.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Regional anticoagulation with calcium\u2010free dialysate enables an acid\u2010 and heparin\u2010free procedure that is more biocompatible and environmentally friendly than conventional bicarbonate hemodialysis. The availability of specific acid\u2010free concentrates and adapted hemodialysis monitors is required to extend this procedure to maintenance hemodialysis.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aor.14764","type":"journal-article","created":{"date-parts":[[2024,5,8]],"date-time":"2024-05-08T08:53:33Z","timestamp":1715158413000},"page":"704-712","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Can regional anticoagulation with calcium\u2010free dialysate be extended to maintenance hemodialysis?"],"prefix":"10.1111","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3531-1912","authenticated-orcid":false,"given":"Thierry","family":"Petitclerc","sequence":"first","affiliation":[{"name":"Hemodialysis Centers, AURA  Paris France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bernard","family":"B\u00e9n\u00e9","sequence":"additional","affiliation":[{"name":"Independent Scholar"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,5,8]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/00002480-199905000-00009"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1159\/000089652"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1038\/ki.1996.112"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/ckj\/sfab087"},{"key":"e_1_2_10_6_1","unstructured":"LebourgL.Regional anticoagulation using a calcium\u2010free citrate\u2010containing dialysate in maintenance hemodialysis. 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