| Abstract | | The use of regional citrate anticoagulation du- t ring hemodialysis is increasing in last years. It is recommended by European Best Practice Guidelines for hemodialysis for the patients where heparin is contraindicated either because of the risk of bleeding or because of increasingly recognized heparin-induced thrombocytopenia. Citrate provides an excellent antithrombotic effect that is limited to the extracorporeal circuit. In addition, citrate increases biocompatibility, since it reduces some of the effects of blood interaction with the dialyzer membrane which are calcium- and magnesiumdependent. It also prevents platelet deposition on dialysis membrane. Because of its low molecular weight it is removed by high-flux dialysis more than 80%. Despite its relatively low price, wider use of citrate is prevented by technical complexity of the procedure. At least as important as regional anticoagulant for hemodialysis is the citrate use for hemodialysis catheter locking in interdialysis period. In addition to excellent local antithrombotic effect and avoidance of systemic anticoagulation, citrate as a locking solution has a significant antimicrobial activity, depending on concentration. The optimal citrate concentration for locking solution is not yet defined. Taking into account many beneficial effects and low cost of citrate we can expect the increase in citrate use both as hemodialysis anticoagulant as well as catheter locking solution.
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