Efficacy of percutaneous angioplasty in non‐maturing Brescia‐Cimino fistulas

Purpose:  To evaluate efficacy of percutaneous transluminal angioplasty (PTA) in non‐maturing Brescia‐Cimino fistulas. Methods:  Between January 1997 and December 2003, we treated 22 patients with non‐maturing Brescia‐Cimino fistulas by PTA. Retrospective analysis was performed on the findings of fistulogram, techniques and success rate of PTA, and patency rate. Results:  Seventeen segmental stenoses and 5 segmental occlusions of cephalic veins were identified. Sixteen stenoses and 2 occlusions were located at the cephalic vein adjacent to the anastomosis site, and 3 occlusions and 1 stenosis were seen at the proximal vein near the elbow joint. In addition to venous stenosis, a focal arterial stenosis at the anastomosis site and two accompanying accessory veins that might hamper maturation of main cephalic vein was seen in each of two patients, respectively. Simultaneous occlusion of left innominate vein as well as occlusion of cephalic vein were noted in one patient. Initial success rate of PTA was 95.5%(21/22). Overall success rate including 11 additional PTAs performed during follow‐up was 96.9%(32/33). No major complication occurred. Primary and secondary patency rates were 72% and 95% at 3 months, and 50% and 77% at 6 months, respectively. Conclusion:  PTA is an effective and safe method in salvaging non‐maturing Brescia‐Cimino fistulas.     

Central venous stenosis in chronic hemodialysis patients: The effect of percutaneous angioplasty and stenting

Background:  Central venous stenosis in chronic hemodialysis patients occurs in about 17% of all venous stenosis and it is associated with central vein catheterization. We evaluated the effect of percutaneous angioplasty and stenting in the treatment of central venous stenosis in hemodialysis patients. Methods:  We retrospectively investigated the medical records of a total of 31 dialysis patients who had central venous stenosis. We reviewed the causes of central venous stenosis, clinical manifestations, venographic findings, and patency rate of radiological intervention. Results:  Of the total 31 patients, 28 patients had past history of central vein catheterization ipsilateral to vascular access. Mean duration of the catheterization was 32 ± 14 days. Venography showed complete obstruction of central vein (n = 14) and stenosis (n = 17). The site of venous lesion was right subclavian vein (n = 11), innominate vein (n = 9), left subclavian vein (n = 7), and superior vena cava (n = 14). A total of 30 procedures of angioplasty with or without stenting were performed in 26 of 31 patients. Initial success rate was 96.1% and there was no severe complication such as rupture or bleeding. The primary patency rate at 6, 12, 24, and 48 months after the procedure was 87.3%, 75.6%, 67.9%, and 65.4%, respectively. The cumulative patency rate at the same time point was 96.0%, 90.6%, 74.0%, and 72.8%, respectively. Conclusion:  Our data suggest that angioplasty with or without stenting is safe and effective in the treatment of central venous stenosis in hemodialysis patients.     

Clinical Experiences High‐flux hemodialysis in the treatment of severe valproic acid overdose: A case report

Introduction:  Hemoperfusion, with or without hemodialysis, has been used to treat patients suffering from severe valproic acid poisoning. We report a patient suffering from severe valproic acid intoxication who was treated effectively with high‐flux hemodialysis alone. Case:  A 20‐year‐old man with a history of bipolar disorder was admitted after having ingested unknown amounts of valproic acid (Depakote®), prednisone, and erythromycin. He was agitated and obtunded but hemodynamically stable initially. Serum valproic acid level was 1,028 μg/mL. Urine toxicology screen as well as serum levels of ethanol, acetaminophen, and acetylsalicylic acid levels were negative. A gastric lavage was followed by activated charcoal instillation. Subsequent myoclonic twitchings that progressed to continuous seizure activity were managed with intravenous lorazepam therapy and endotracheal intubation. Serum valproic acid value measured two hours after admission remained elevated at 1,046 μg/mL. Hemodialysis was performed continuously for 10.5 hours using a high‐flux, polysulfone dialyzer (Polyflux 21S, Fresenius Medical Care, Lexington, MA), a dialyzer blood flow of 200–300 mL/min, and a dialysate flow of 500 mL/min. The therapy brought about a fall in serum valproic acid level to 110 μg/mL and a complete recovery of the patient. Discussion:  Valproic acid (144 Dalton) is 90–95% protein‐bound at therapeutic serum values. However, in the face of an overdose, the unbound fraction rises because of saturation of protein‐binding sites. This unbound fraction is readily dialyzable. We suggest that high‐flux hemodialysis is effective in the treatment of severe valproic acid poisoning.     

Intermittent and short daily hemodialysis increase HGF plasma levels and diminish HCV viral load

Decrease of HCV viral load and HGF plasma levels increase have been related to HD sessions. Beneficial effects of HGF stimulation in HD on the outcome of HCV liver disease have been described. Aim was to analyze potential differences between intermittent (3 × week) and short daily (6 × week) HD, examining differences between HCV+ and – pts. We studied 41 pts from 2 HD centres, 26 on intermittent HD (6 on line HF), 8 HCV+, and 15 on short‐daily HD with 4 HCV+ 40 pts used synthetic HD membranes (low‐flux and high‐flux). Among HCV + we determined viral load by Amplicor (Roche) pre- and post- HD. All pts were studied for HGF levels (ELISA) baseline, 15 min, end, and at start of the following session viral load is significantly higher preHD and decreases over session. High‐flux membranes were more efficient in reducing viremia (67% vs 45%), which level was higher pre‐ and post‐HD principally in patients using low‐flux membranes. Viremia in DHD is lower than in intermittent (470067.3 ± 663974.5 vs 1015695.5 ± 1202679.0).  

     

Successful tunneled catheter placement in a hemodialysis patient with idiopathic multiple central venous stenoses

Central venous stenosis (CVS) in hemodialysis patients could be secondary to central venous catheterization, high flow arteriovenous fistula, as well as extrinsic compression. However, we report a senile hemodialysis patient of left internal jugular vein stenosis and right innominate vein occlusion unrelated to any known risk factors. Aided by computed tomography and digital subtraction angiography, we managed to dilate the stenosis by percutaneous balloon angioplasty, followed by successful tunneled catheter placement. Nephrologists should be aware of idiopathic CVS and its impact on the creation and preservation of vascular access. When confronted with difficulties in catheter placement, practitioners need to consider the possibilities of idiopathic CVS and refer to radiological tests.     

Access High output heart failure in patients with upper arm A‐V fistulae: Diagnosis and treatment

Purpose: Arteriovenous fistula (AVF) is the preferred blood access for hemodialysis due to its longevity and resistance to infection. Little attention is given to the long-term hemodynamic consequences of large left‐to‐right shunts, particularly in patients with brachial artery fistulae. Materials and Methods:  We describe 9 patients (8 on dialysis, 1 post‐transplant), aged 25–73, who developed clinical heart failure, primarily due to large, upper arm AVFs. Results:  4/9 had access flows in excess of 2 liters/min, assessed by blood temperature monitoring. 6/9 had cardiac output measured by right heart catheterization, before and after shunt compression. One also underwent left heart catheterization with ventriculography. 3/9 had surgical reduction of the fistula, either by banding or by serial interposition of small caliber GoreTex graft. In 2/9 the shunt was ligated. One patient had heart failure in association with 2 large, upper arm AVFs, one of which was ligated. After years of improved cardiac symptoms, heart failure recurred in association with marked hypertrophy of his remaining AVF. Resting cardiac output in this patient was in excess of 11 liters/min. 2/9 experienced acute onset of heart failure within 1–3 days of angioplasty of a venous stenosis. One of these, with very poor baseline cardiac function, expired. Surgical revision or ligation was accompanied by clinical improvement in the 5 patients so treated. One of these expired of a stroke after two months of cardiac improvement. Conclusion:  High output heart failure is under‐diagnosed in dialysis patients. Patients with large upper arm shunts are particularly at risk. Access flow should be assessed regularly and those with outputs >1.5 liters/min should be monitored closely for development of heart failure. Surgical correction is beneficial and indicated in symptomatic patients.  

     

Relationship Between Vascular Access Flow and Hemodynamically Significant Stenoses in Arteriovenous Grafts

Background: Vascular access dysfunction is a major source of hemodialysis patient morbidity. The NKF K/DOQI Guidelines promote access flow monitoring as the most preferred access surveillance method and have established access flow thresholds for fistulography: an absolute threshold of 600 ml/min and a dynamic threshold of flow less than 1000 ml/min that has decreased by more than 25% over 4 months. The Guidelines apply universally to accesses of different types, sizes, locations, and initial flow rates.
Methods: This article studies the application of access flow guidelines with human experimental data, animal experimental data, and a mathematical model of the arteriovenous graft system.
Results and conclusions: Analysis of experimental data and the mathematical model shows that a 20 to 30% and greater decrease in graft flow generally suggests the appearance of hemodynamically significant stenosis as defined by flow criteria. The model suggests that not all 50 to 60% stenoses may be hemodynamically significant or the most flow limiting. The mathematical model also suggests that positive predictive value of access surveillance may be increased for high‐flow upper arm grafts by increasing the dynamic K/DOQI threshold from 1000 ml/min to 1200 ml/min.     

Longitudinal micro-incision creation prior to balloon angioplasty for treatment of arteriovenous access dysfunction in a real-world patient population: 6-month cohort analysis

Introduction

Routine hemodialysis depends on well-functioning vascular access. In the event of vascular access dysfunction, percutaneous transluminal balloon angioplasty (PTA) is conducted to restore patency. Although an angioplasty procedure can provide an excellent immediate result by opening the access to allow dialysis to continue, the long-term patency rates are less than satisfactory. The goal of this study was to assess the outcomes of patients who underwent a novel vessel preparation via longitudinal, controlled-depth micro-incisions prior to PTA.

Methods

This multicenter, prospective, observational registry enrolled hemodialysis patients scheduled to undergo PTA of their arteriovenous fistula or graft due to clinical or hemodynamic abnormalities. A primary endpoint was anatomic success, defined as angiographic confirmation of <30% residual stenosis post-procedure without an adverse event. Additional assessments included device technical success, clinical success, freedom from target lesion revascularization, target lesion primary patency, and circuit primary patency at 6 months.

Findings

A total of 148 lesions were treated with the FLEX Vessel Prep™ System (FLEX VP) prior to PTA in 114 subjects at eight clinical sites. Target lesions were 21 ± 25 mm in length with mean pre-procedure stenosis of 75.2% ± 4.7%. Five procedural complications were recorded without serious adverse events. Two subjects did not complete the follow-up evaluation. Target lesion primary patency across all subjects at 6-months was 62.2% with mean freedom from target lesion revascularization of 202.7 days. Target lesion primary patency and freedom from target lesion revascularization for AVF cases (n = 72) were 67.5% and 212.9 days, respectively. Target lesion primary patency and freedom from target lesion revascularization for AVGs (n = 42) were 52.4% and 183.3 days, respectively. In cases treating AVF cephalic arch stenosis (n = 25), 6-month target lesion primary patency was 70.6% and freedom from target lesion revascularization was 213.4 days.

Discussion

This FLEX-AV registry demonstrates safety and effectiveness, notably in the cephalic arch and AVGs, when FLEX VP is used prior to PTA for treatment of vascular access dysfunction in a population of end-stage renal disease subjects.     

Single‐dose pharmacokinetics (PK) of ferric gluconate (FG) in iron‐deficient pediatric hemodialysis patients

Purpose: Limited information exists on the use of any intravenous iron preparation in pediatric HD patients. This study was designed to describe the PK parameters of FG, now approved for use in children on HD. Methods: Iron‐deficient pediatric HD pts (≤15 yr) were randomized to 2 doses of FG. Blood samples taken during a 1 hr infusion and at intervals over 48 hrs were analyzed for total iron, transferrin‐bound iron (TBI), and FG‐bound iron (FGI). Results: 49% of pts were male, 88% white, 57% age 6–12 yr, wt 16.3–63.2 Kg, ht 100–177.5 cm. Mean serum iron concentrations (total iron and FGI) rapidly increased in a dose‐dependent manner, approximately proportional to the FG dose administered. A rapid rise in total serum iron was followed by a slower, less prominent rise in TBI. Single‐dose PK of FGI was adequately described using non‐compartmental analytical methods. A standard 2‐compartment NONMEM model successfully fit the data and accurately described the time‐course of FGI concentrations.  

     

A study of 8 hour long night dialysis with the Aksys PHD dialysis system

The Aksys PHD system is designed for short quotidian dialysis employing a 52‐liter batch of ultrapure dialysate and up to 30 in situ hot water reuses of the entire extracorporeal circuit including a 40‐liter physical cleaning before each dialysis. Methods:  We studied the effect of the 52‐liter tank during 108 long 5–8 hour dialysis 3.5–6 times/week in 5 patients and one 50‐liter patient simulator for 4 weeks. Phosphate (PO₄), beta‐2 microglobulin (b‐2), urea (BUN), and creatinine (creat) were measured pre‐, during, and post‐dialysis 86 times and in total dialysate 74 times during long dialysis. Tank saturation, Kt/V, and monthly chemistries were also measured. Results:  Patient weight 76 ± 2 kg, QB 234 ± 23 ml/min, QD 498 ± 13 ml/min. Dialysate was recirculated 4.8 times during 8 hours.  

     

Efficacy of Tissue Plasminogen Activator for Thrombolysis in Central Venous Dialysis Catheters

Background:  Low blood flow is a frequent complication of central‐vein (CV) dialysis catheters. Since thrombotic occlusion accounts for many cases of reduced blood flow, it is common practice to administer empiric thrombolytic therapy in an attempt to restore catheter patency and improve function.
Methods:  We prepared tissue plasminogen activator (tPA) from 50 mg lyophilized powder, which was diluted (1 mg/mL) in sterile water for injection. A volume of 1 mL was frozen in 3 cc polystyrene syringes at −20 °C and thawed at room temperature when needed. tPA was then administered into the arterial and venous ports of the central venous catheter in a volume equal to the manufacturer's stated luminal volume and was allowed to dwell for 30 minutes.
Results:  tPA was administered 62 times in 25 patients with 30 catheters (11 Tesio, 17 PermCath, 2 Shiley) for treatment of low blood flow (pump speed < 250 mL/min). Complete restoration of patency was achieved in 23 episodes (mean blood flow pre‐tPA 130 mL/min; post‐tPA 320 mL/min); partial restoration of patency was achieved in 20 episodes (mean blood flow pre‐tPA 69 mL/min; post‐tPA 233 mL/min). tPA was just as likely to be effective in patients with complete catheter occlusion (i.e., no blood flow) as it was when some initial blood flow was present. Nineteen episodes failed to respond to tPA. These episodes occurred in 13 catheters, 12 of which ultimately underwent radiologic evaluation; an extraluminal cause for low blood flow was found in all 12 catheters (6 malpositioned, 6 fibrin sheaths).
Conclusions:  tPA at a dose of 1 mg/mL is effective for restoring patency in CV dialysis catheters. Failure to respond to tPA strongly suggests an extraluminal cause of catheter malfunction.     

Multiple factors affect 3‐year survival of patients on chronic hemodialysis

One of the basic symptoms of a terminal stage chronic renal insufficiency is anemia. From everything, used methods of correction of an anemia, it is considered the most effective application of preparations recombinant human erythropoietin (r‐Hu EPO). Since 1994 in the Scientific Centre of Surgery begins application r‐Hu EPO. Application r‐Hu EPO in patients with a terminal stage chronic renal insufficiency in 90–95% of cases had a positive effect, but 5–10% of patients have intolerance to erythropoietin, that has induced to search of new effective methods of correction of anemia. During research were determined quantity erythrocytes, hemoglobin, reticulocyte in peripheral blood and acid‐alkaline condition of blood. All hematology parameters were defined at the beginning of treatment, over 5 day and for 15 day of stimulation of a bone marrow. For 15 days after stimulation of a bone marrow by the laser there was an authentic increase of quantity erythrocyte, hemoglobin, hematocrit. The initial contents erythrocytes made 2.22 ± 0.1 10 × 12, hemoglobin 67.7 ± 3.2 g/l and hematocrit 18.2 ± 1.2%. During treatment by the laser parameters erythrocytes have increased up to 2.9 ± 0.8 10 × 12, hemoglobin up to 89.6 ± 2.9 g/l and hematocrit up to 28.2 ± 1.3%(P < 0,005). Hematology parameters in blood of control group authentically have not changed.     

Late onset of clinically apparent central vein stenosis due to previous central venous catheter in a patient with inherited thrombophilia

We describe a case of a patient with a functional kidney transplant who was admitted to our department with clinically evident central vein stenosis (CVS) 7 years after the removal of a central venous catheter (CVC) from the right internal jugular vein. The catheter was used as a hemodialysis access for a 2‐month period. In the interval before his last admission, the patient suffered two episodes of deep vein thrombosis. Investigation revealed heterozygosity for factor V Leiden, the most common inherited thrombophilia encountered in 5% of Caucasians, and anticoagulation treatment was started. Magnetic resonance angiography showed stenosis just after the convergence of the right subclavian vein with the internal jugular vein to the innominate vein. Transluminal angioplasty restored venous patency and right upper arm edema resolved. Coexistence of CVS, accompanied by hemodynamic changes and endothelial dysfunction, with thrombophilia fulfill all the elements of the Virchow's triad. Therefore, the patient was at great risk for central vein thrombosis, from which he was possibly protected by the early administration of anticoagulant treatment. This case indicates that CVS can be asymptomatic for several years after CVC removal and also raises the question if thrombophilia workup and investigation for CVS may be beneficial in every patient with CVC placement in order to avoid any harmful outcomes.     

Studies of phosphate dynamics during hemodialysis

Regulation of phosphate (PO₄) in hemodialysis patients is very difficult and ideal levels are rarely maintained. A high removal and a normal phosphate level is important, as high and low levels are both associated with morbidity and a very high mortality.
We studied phosphate dynamics and its relation to other small "uremic" molecules in 48 patients by measuring pre‐ and postdialysis levels and all removed phosphate, urea and creatinine (creat) in all dialysate during 455 dialyses done at different frequencies (freq): 3.7 ± 1.2, range 3–6 treatments per week and durations of dialysis (t): mean: 196 ± 95, range 80–560 min and with high (HF) and low flux membranes.
Kt/V‐PO₄, Kt/V‐urea and Kt/V‐creat, volumes (Vr) for all solutes and their relationships to frequency and duration of dialysis, urea clearance and predialysis phosphate were calculated.  

     

Uremic Toxins: Removal with Different Therapies

A convenient way to classify uremic solutes is to subdivide them according to the physicochemical characteristics influencing their dialytic removal into small water‐soluble compounds (<500 Da), protein‐bound compounds, and middle molecules (>500 Da). The prototype of small water‐soluble solutes remains urea although the proof of its toxicity is scanty. Only a few other water‐soluble compounds exert toxicity (e.g., the guanidines, the purines), but most of these are characterized by an intra‐dialytic behavior, which is different from that of urea. In addition, the protein‐bound compounds and the middle molecules behave in a different way from urea, due to their protein binding and their molecular weights, respectively. Because of these specific removal patterns, it is suggested that new approaches of influencing uremic solute concentration should be explored, such as specific adsorptive systems, alternative dialytic timeframes, removal by intestinal adsorption, modification of toxin, or general metabolism by drug administration. Middle molecule removal has been improved by the introduction of large pore, high‐flux membranes, but this approach seems to have come close to its maximal removal capacity, whereas multicompartmental behavior might become an additional factor hampering attempts to decrease toxin concentration. Hence, further enhancement of uremic toxin removal should be pursued by the introduction of alternative concepts of elimination.     

The use of near infrared interactance in hemodialysis

Forty‐one consecutive admissions to a hemodialysis center were evaluated. Demographic information including age, gender, race, and diagnosis was collected. Patients, >18 years old, with end stage renal disease and on hemodialysis for at least one year were included. Those with edema or known ascites were excluded. Weight was measured before and after hemodialysis (HD) using a standard scale and by considering the amount of fluid loss by the hemodialysis machine. Body composition including total body water (TBW) was calculated before and after HD using near infrared interactance (NIR). All measurements were completed during half hour before and after HD. Forty‐one patients included: men (n = 26), women (n = 15); median age 58 (range 28–88 years). Twenty‐eight were African American and the rest Caucasians. The amount of intravascular fluid taken after HD (assessed by weight reduction) ranged 0–5 L with median 2.2 L. NIR analysis for the same patients at the same time showed different total body water measurements in 91% of cases (P > 0.05). Moreover, NIR analysis showed increase in total body water in 24% of patients even though the hemodialysis machine showed a loss of total body water; median of 1.3 (range: 0–3L). The error in measuring body composition with NIR was both large and varied (random and not systematic error). We conclude that NIR analysis cannot be considered as a reliable method to evaluate body composition, especially total body water, amongst patients with end stage renal disease undergoing hemodialysis.     

Predicting Acute Renal Failure after Cardiac Surgery: Validation and Re‐definition of a Risk‐Stratification Algorithm

Background:  Acute renal failure (ARF) after cardiac surgery is associated with significant morbidity and mortality, irrespective of the need for dialysis. Previous studies have attempted to identify predictors of ARF and develop risk stratification algorithms. This study aims to validate the algorithm in an independent cohort of patients that includes a significant proportion of female and black patients and compares two different definitions of renal outcome.
Methods:  A large single center cardiac surgery database was examined (n, 24,660; 1993–2000) which included 29.9% females and 3.7% black patients. Post‐operative ARF was defined as: a) ARF requiring dialysis, b) > 50% reduction in creatinine clearance relative to baseline or requiring dialysis. Clinical variables related to baseline renal function and cardiovascular disease were used in recursive partitioning analysis for both outcome definitions. Chi‐square goodness of fit analysis was performed to validate the algorithm.
Results:  The frequency of post‐operative ARF requiring dialysis ranged between 0.5 and 15.5% based on the risk categories with the area under the receiver operating characteristic (ROC) curve of 0.78. Using the more inclusive definition of ARF, the frequency was significantly higher ranging from 2.6 to 25%(P < 0.001) with an area under ROC curve of 0.65.
Conclusions:  The renal risk stratification algorithm is valid in predicting post‐operative ARF in an independent cohort of patients, well represented by differences in gender and race. Since the need for dialysis remains subjective, a more objective and inclusive definition of ARF may help in identifying a larger number of patients 'at‐risk'.     

Vitamin D receptor BsmI and TagI gene polymorphisms in Turkish ESRD population and influences on parathyroid hormone response

Background/Aim:  Clinical presentation and complications of end‐stage renal disesase (ESRD) patients are under influence of many enviromental and genetic factors. In this study we aimed to define frequencies of BsmI and TagI Vitamin D receptor (VDR) gene polymorphisms and possible influences on clinical presentations in Turkish ESRD population. Methodology and Patients:  186 patients (111 male, 75 female) who are being maintained on hemodialysis were included. Genotyping was performed for the insertion/deletion BsmI (B→b, restriction site, exon VIII→IX), TagI (T→t, 352 exon IX) VDR gene polymorphisms. Last 12 months' laboratory values (C‐reactive protein, intact parathyroid hormone, albumin, calcium, phosphorus, Ca x P product) and clinical findings (vitamin D requirement, body weight) were recorded and analysed retrospectively. Results:  Mean age and follow‐up period lengths were 42.1 ± 12.6 years and 76.3 ± 43.9 months, respectively. Polymorphism percentages were as follows: BsmI; BB/Bb/bb: 28.9/65.3/5.8%, TagI; TT/Tt/tt: 36.7/60.5/2.8%, respectively. Further analysis revealed that TT variant of TagI was related with hyperparathyroidism (p < 0.05). Analysis of data after regrouping patients according to iPTH levels (0–249, 250–499, 500 + pg/mL) and hemodialysis duration (<60 vs ≥60 months) revealed that influence of TT variation on hyperparathyroidism became more frequent in case of increased hemodialysis duration and iPTH levels (p < 0.005). Conclusion:  TT variation of TagI VDR gene influences the development of hyperparathyroidism in HD patients. This influence becomes more evident in patients with longer HD duration.     

Experimental study on a new type citrate anticoagulant hemodialysate in dogs

Objective:  In this study, we initiated a new hemodialysate with citrate buffer, observed the factors that influence the citrate concentration of solution in hollow fibers when using citrate hemodialysate, and observed the anticoagulant effect and safety of the citrate hemodialysate in the experiment in dogs. Methods:  Ten dogs were given intermittent hemodialysis and were divided into 3 groups according to hemodialysis procedures. Group 1 was saline‐flush hemodialysed with bicarbonate hemodialysate; Group 2 was hemodialysed with citrate hemodialysis without any anticoagulant; Group 3 was hemodialysed with bicarbonate hemodialysate and heparin. ACT, Ca⁺⁺, BUN, Cr, ALT, AST, TBIL, DBIL, Na⁺, Cl⁻,     , and venous pressure were monitored in the animals of each group during hemodialysis. Results:  During the hemodialysis in Group 1, venous pressure increased lastingly, resulting in the failure of hemodialysis for 2 hours. Hemodialysis for 2 hours in Group 2 were all finished successfully. ACT was extended and Ca⁺⁺ decreased obviously in the venous end during hemodialysis. And ALT, AST, Ca⁺⁺, K⁺, Na⁺, Cl⁻,     after the hemodialysis in Group 2 were not changed (P > 0.05). Moreover, the clearance rate of the dialyzers with citrate dialysate increased significantly compared with those of saline‐flush and heparin anticoagulation. Conclusions:  The anticoagulant and dialytic effects of the new type citrate hemodialysis are satisfactory and better than that of saline‐flush.