Dialysis anticoagulation by Ca-free dialysate and low-dose gabexate mesilate (FOY)

Dialysis anticoagulation was performed by Ca-free dialysate and low-dose FOY. The dialyzers used were Toray B2-100 and B2-200. The composition of the Ca-free dialysate was as follows: Na139mEq/l, K2.5mEq/l, Cl103mEq/l, Mg1.5mEq/l, HCO3- 20mEq/l, citrate 20mEq/l, and glucose (200mg/dl). Ionized Ca, total Ca, and Kaolin-activated whole blood clotting time (KCT) were measured. Citrate (20mEq/l) in the dialysate deionizes not only a trace amount of dialysate Ca but also blood Ca, because citrate is transferred from the dialysate to the blood by dialysis. Consequently, ionized Ca was decreased and KCT was considerably prolonged at the outlet of the dialyzer. Decreased ionized Ca and prolonged KCT were corrected by infusion of 2% CaCl2 solution at the end of extracorporeal circulation. Ca-free dialysis with low-dose FOY was performed 20 times on 8 hemodialysis patients. FOY at about 400mg/hr was required to prevent clotting in the arterial drip chamber for 7 patients. Anticoagulation by only Ca-free dialysate was possible in one patient. It is concluded that dialysis anticoagulation by Ca-free dialysate in combination with low-dose FOY is useful in patients with a high-risk bleeding tendency.