20.500.12556/RUL-183098 Comparison of biocompatibility and efficacy of regional citrate anticoagulation and unfractionated heparin during expanded hemodialysis with a medium cut-off membrane a randomized trial Background: Regional citrate anticoagulation (RCA) improves the biocompatibility of hemodialysis (HD) by reducing activation of complement, leukocytes, and platelets. Despite the new possibility of expanded hemodialysis (HDx), RCA and unfractionated heparin (UFH) have not been compared in this dialysis modality. This study compared the biocompatibility and efficacy of RCA versus full-dose UFH during HDx. Methods: In a randomized cross-over trial, 32 chronic HD patients each underwent two HDx sessions with a Theranova dialyzer: one with RCA and one with UFH. Biocompatibility was assessed by plasma complement factor 3a (C3a), myeloperoxidase (MPO), and platelet factor 4 (PF4) measured pre-HDx, after 15min, and at session end. In a subset of patients (n=5), scanning electron microscopy (SEM) visualized cell adhesion and clotting on dialyzer fibers. Efficacy outcomes were overall clearances and reduction ratios (RR) for creatinine, urea, and β2-microglobulin. Results: MPO and C3a increased after 15min of HDx only with UFH (p < 0.001). In the available PF4 data, a significant increase after 15min of HDx occurred only with UFH (p=0.02). SEM showed minimal cell adhesion with both anticoagulants. Overall clearances and RRs of creatinine, urea, and β2-microglobulin did not differ. RCA was well tolerated, with no significant electrolyte disturbances. Conclusions: RCA during HDx provided superior biocompatibility over UFH, eliminating complement, granulocyte, and platelet activation without improving dialysis efficacy. citrate heparin anticoagulation biocompatibility efficacy hemodialysis hemodializa antikoagulacija citrat učinkovitost biokompatibilnost true false true Angleški jezik Slovenski jezik Članek v reviji 2026-06-04 12:09:06 2026-06-04 12:09:15 2026-06-07 03:23:45 0000-00-00 00:00:00 2026 0 0 Str. 809–812 iss. 6 Vol. 50 2026 0000-00-00 Zaloznikova Objavljeno NiDoloceno 0000-00-00 0000-00-00 0000-00-00 616 1525-1594 10.1111/aor.70085 264091907 Artificial_Organs_-_2026_-_Malgaj_Vrecko_-_Comparison_of_Biocompatibility_and_Efficacy_of_Regional_Citrate_Anticoagulation.pdf Artificial_Organs_-_2026_-_Malgaj_Vrecko_-_Comparison_of_Biocompatibility_and_Efficacy_of_Regional_Citrate_Anticoagulation.pdf 1 2667968959335D58634BD66E9D28F444 f2ae2a77dfdfa69ee234cbb7cb235f23ec7180125d127c6931525b596097fbf5 7acbd693-60ae-11f1-b0ab-0050569b8976 https://repozitorij.uni-lj.si/Dokument.php?lang=slv&id=235002 https://onlinelibrary.wiley.com/doi/10.1111/aor.70085 0 571efc5c-5ffe-11f1-b0ab-0050569b8976 https://repozitorij.uni-lj.si/Dokument.php?lang=slv&id=234953 Medicinska fakulteta Fakulteta za farmacijo 0 0 0