Trakarnvanich T, et al. - Researchers tested the effects of citrate compared with acetate when used for preventing extracorporeal circuit clotting during renal replacement therapy, on heparin avoidance and other parameters. They switched 61 chronic hemodialysis (HD) patients from conventional dialysis fluid (acetate) to citrate dialysis fluid and treated them in 3 phases, each lasting 4 weeks: 50%, 25%, and no heparin. Throughout each citrate phase, the same dialyzers were used except for 2 episodes of clotting. Comparable mean visual clotting scores were noted across the study periods. In phase 2, hemoglobin decreased slightly despite the constant erythropoiesis stimulating agent dose. As per outcomes, heparin can be completely avoided during citrate dialysis in chronic HD patients. Further, maintenance of the electrolyte levels, the adequacy of dialysis, and hemoglobin can be achieved without significant adverse events.