Comparison of ordinary calcium-containing dialysate segmented regional citrate anticoagulation hemodialysis and heparin-free hemodialysis in patients with high risk of bleeding

doi:10.16138/j.1673-6087.2023.05.003

Abstract

Abstract: Objective To investigate the safety and efficacy of regional citrate anticoagulation (RCA) with ordinary calcium-containing dialysate in hemodialysis, and compare its differences in coagulation status and treatment time with heparin-free hemodialysis in high-risk bleeding patients. Methods Maintenance hemodialysis patients with high risk of bleeding from Dalian Municipal Central Hospital from January in 2019 to December in 2021 were selected, a total of 35 patients were enrolled (19 males and 16 females), and they received heparin-free hemodialysis or 4% sodium regional citrate anticoagulation treated hemodialysis. Citrate was infused into the arterial line and vein line through the dialyzer. The electrolyte, blood pressure, and coagulation system in hemodialysis patient were compared before and after the application of segmented citrate anticoagulation. The differences of coagulation and treatment time between the two methods were compared. Results In the citrate treated group, through adjusting the parameters of the dialysis machine online, the serum sodium could be kept stable after dialysis(P>0.05). Hypocalcemia didn’t occur in the application of calcium-containing dialysate (1.5 mmol/L), while serum calcium increased after dialysis (P<0.05). The blood pressure and heart rate of the patients in the citrate treated group were stable before and after dialysis(P>0.05). Activated partial thromboplastin time (APTT) of patients after local citrate anticoagulation was prolonged compared with that before dialysis(P<0.05), and the remaining coagulation time was not significantly different from that before dialysis (P>0.05). In the citrate treated group, the anticoagulation efficacy of the dialyzer and venous pot (P<0.05), ultrafiltration volume (P<0.05) and urea clearance index(Kt/V)(P<0.001) were significantly higher than those in the non-heparin group, while the actual dialysis time was longer than that in the non-heparin group (P<0.001). Conclusions The segmented regional citrate anticoagulation of ordinary calcium-containing dialysate is safe and effective in high-risk bleeding risk dialysis patients, and its anticoagulant effect is better than that in heparin-free hemodialysis.

Key words: Regional citrate anticoagulation, Heparin-free hemodialysis, Calcium-containing dialysate, End-stage renal disease

CLC Number:

R692

ZHANG Yu, WANG Zhihong, DONG Cui, KUAI Tingting, YOU Lianlian, LIU Shuxin. Comparison of ordinary calcium-containing dialysate segmented regional citrate anticoagulation hemodialysis and heparin-free hemodialysis in patients with high risk of bleeding[J]. Journal of Internal Medicine Concepts & Practice, 2023, 18(05): 322-327.

Figures/Tables 4

References 31

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项目	透析前	透析2 h	透析后	F	P
pH	7.39±0.05	7.44±0.05	7.46±0.06	59.692	<0.01
BE（mmol/L）	-3.09±3.19	-0.62±2.40	0.64±2.33	42.568	<0.01
HCO₃^-（mmol/L）	21.87±2.62	23.71±1.90	24.46±1.87	33.059	<0.01
血钠（mmol/L）	136.89±4.52	136.34±2.35	135.89±1.78	2.381	0.125
血钾（mmol/L）	4.08±0.61	3.56±0.38	3.49±0.32	26.253	<0.01
离子钙（mmol/L）	1.12±0.11	1.14±0.08	1.16±0.08	5.775	0.017

项目	透析前	透析2 h	透析结束	F	P
收缩压（mmHg）	156.46±19.97	153.29±19.85	155.83±20.61	1.236	0.297
舒张压（mmHg）	83.80±12.73	81.43±10.45	86.23±13.18	2.652	0.095
心率（次/min）	79.37±11.17	78.60±10.38	78.63±9.65	0.428	0.654
静脉压（mmHg）	101.83±29.10	107.34±23.56	118.51±38.73^1）	5.403	0.018
跨膜压（mmHg）	84.26±26.30	90.51±30.60^1）	90.66±34.79^1）	3.999	0.034

项目	透析前	透析后	t	P
PT（s）	13.48±1.81	13.81±1.51	-1.242	0.223
INR	1.09±0.15	1.07±0.14	1.057	0.298
APTT（s）	35.49±6.79	38.97±5.25	-3.137	0.004
FIB（g/L）	3.97±1.57	3.79±1.40	1.498	0.143
TT（s）	17.56±2.29	17.03±1.89	1.622	0.114

项目	无肝素组	枸橼酸组	t/χ²	P
透析器
0~Ⅰ级	20	29
Ⅱ级	8	5
Ⅲ级	7	1
有效率（%）	80.0	97.1		0.027^*
静脉壶
0~Ⅰ级	12	27
Ⅱ级	12	7
Ⅲ级	11	1
有效率（%）	68.6	97.1	10.057	0.002
平均超滤率	745.17±231.14	641.91±183.59	-2.002	0.053
超滤量（L）	1.86±0.65	2.40±0.80	2.825	0.008
透析时间（min）	146.91±34.83	226.00±23.85	11.051	<0.001
Kt/V	1.13±0.16	1.31±0.19	7.987	<0.001