Journal of Internal Medicine Concepts & Practice >

2023 , Vol. 18 >Issue 05: 322 - 327

DOI: https://doi.org/10.16138/j.1673-6087.2023.05.003

Original article

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

Expand
  • Department of Nephrology, Dalian Key Laboratory of Intelligent Blood Purification, Dalian Municipal Central Hospital, Dalian 116033, China

Received date: 2023-02-21

  Online published: 2024-01-25

Fold

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

Cite this article

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 . DOI: 10.16138/j.1673-6087.2023.05.003

References

[1] Wang W, Zhang S, Li Y, et al. Application of simplified regional citrate anticoagulation in hemodialysis patients with high risk of bleeding[J]. Clin Nephrol, 2022, 97(6):311-320.
[2] Khwaja A. KDIGO clinical practice guidelines for acute kidney injury[J]. Nephron Clin Pract, 2012, 120(4): c179-c184.
[3] Ashby D, Borman N, Burton J, et al. Renal association clinical practice guideline on haemodialysis[J]. BMC Nephrol, 2019, 20(1): 379.
[4] 陈香美. 血液净化标准操作规程(2021版)[M]. 北京: 人民卫生出版社, 2021: 110-112.
[5] 张少岩, 李月红, 杨画, 等. 简化枸橼酸抗凝血液透析治疗方案在高出血风险患者血液透析中的应用[J]. 临床内科杂志, 2021, 38(1): 34-36.
[6] 阳柳, 吴欣, 李晓颖, 等. 两段式枸橼酸抗凝在普通血液透析的效果[J]. 实用医学杂志, 2020, 36(23): 3260-3263.
[7] 水光兴, 邹峰, 贺丹, 等. 简化枸橼酸抗凝在血液透析高危出血倾向患者中的临床应用研究[J]. 中国中西医结合肾病杂志, 2021, 22(3): 237-239.
[8] Kozik-Jaromin J, Nier V, Heemann U, et al. Citrate pharmacokinetics and calcium levels during high-flux dialysis with regional citrate anticoagulation[J]. Nephrol Dial Transplant, 2009, 24(7): 2244-2251.
[9] 庄峰, 毕逍, 丁峰. 长时间枸橼酸抗凝在维持性血液透析患者中的疗效观察[J]. 临床肾脏病杂志, 2020, 20(9): 740-744.
[10] 杨松涛, 赵娜, 胡军, 等. 应用普通含钙透析液局部枸橼酸抗凝血液透析的临床观察[J]. 中国血液净化, 2017, 16(7): 474-476.
[11] 朱淑华, 樊蓉, 徐斌, 等. 简化枸橼酸抗凝无肝素透析的疗效观察[J]. 肾脏病与透析肾移植杂志, 2017, 26(4): 323-327.
[12] 梅长林, 叶朝阳, 赵学智,主编. 实用透析手册[M]. 北京: 人民卫生出版社, 2003: 99.
[13] Rossignol P, Dorval M, Fay R, et al. Rationale and design of the HepZero study: a prospective, multicenter, international, open, randomized, controlled clinical study with parallel groups comparing heparin-free dialysis with heparin-coated dialysis membrane (Evodial) versus standard care: study protocol for a randomized controlled trial[J]. Trials, 2013, 14: 163.
[14] Morita Y, Johnson RW, Dorn RE, et al. Regional anticoagulation during hemodialysis using citrate[J]. Am J Med Sci, 1961, 242: 32-43.
[15] Zarbock A, Küllmar M, Kindgen-Milles D, et al. Effect of regional citrate anticoagulation vs systemic heparin anticoagulation during continuous kidney replacement therapy on dialysis filter life span and mortality among critically Ⅲ patients with acute kidney injury[J]. JAMA, 2020, 324(16): 1629-1639.
[16] Gould DW, Doidge J, Sadique MZ, et al. Heparin versus citrate anticoagulation for continuous renal replacement therapy in intensive care: the RRAM observational study[J]. Health Technol Assess, 2022, 26(13): 1-58.
[17] Bauer E, Derfler K, Joukhadar C, et al. Citrate kinetics in patients receiving long-term hemodialysis therapy[J]. Am J Kidney Dis, 2005, 46(5): 903-907.
[18] Yessayan L, Sohaney R, Puri V, et al. Regional citrate anticoagulation "non-shock" protocol with pre-calculated flow settings for patients with at least 6 L/hour liver citrate clearance[J]. BMC Nephrol, 2021, 22(1): 244.
[19] Evenepoel P, Maes B, Vanwalleghem J, et al. Regional citrate anticoagulation for hemodialysis using a conventional calcium-containing dialysate[J]. Am J Kidney Dis, 2002, 39(2): 315-323.
[20] Leroy C, Pereira B, Soum E, et al. Comparison between regional citrate anticoagulation and heparin for intermittent hemodialysis in ICU patients[J]. Ann Intensive Care, 2021, 11(1): 13.
[21] Davenport A, Tolwani A. Citrate anticoagulation for continuous renal replacement therapy (CRRT) in patients with acute kidney injury admitted to the intensive care unit[J]. NDT Plus, 2009, 2(6): 439-47.
[22] Wang Y, Wang D, Wei G, et al. Improved co-production of S-adenosylmethionine and glutathione using citrate as an auxiliary energy substrate[J]. Bioresour Technol, 2013, 131: 28-32.
[23] Orsag A, Bozic-Mijovski M, Hudoklin S, et al. Biocompatibility parameters with standard and increased dose of citrate in hemodialysis—a randomized trial[J]. J Clin Med, 2021, 10(13): 2987.
[24] 席春生, 刘同存, 方春天, 等. 影响简化局部枸橼酸抗凝有效性的多因素分析[J]. 中国中西医结合肾病杂志, 2021, 22(1): 55-57.
[25] Lin T, Song L, Huang R, et al. Modified regional citrate anticoagulation is optimal for hemodialysis in patients at high risk of bleeding: a prospective randomized study of three anticoagulation strategies[J]. BMC Nephrol, 2019, 20(1): 472.
[26] Lim EK, Seow YT, Chen SE, et al. Simple citrate anticoagulation protocol for low flux haemodialysis[J]. BMC Nephrol, 2018, 19(1): 16.
[27] Gritters M, Grooteman MP, Schoorl M, et al. Citrate anticoagulation abolishes degranulation of polymorphonuclear cells and platelets and reduces oxidative stress during haemodialysis[J]. Nephrol Dial Transplant, 2006, 21(1):153-159.
[28] Bi X, Zhang Q, Zhuang F, et al. An observational cohort study of the 2-month use of regional citrate anticoagulation in maintenance hemodialysis patients with cerebral hemorrhage[J]. Med Sci Monit, 2021, 27: e930513.
[29] Kameda S, Fujii T, Ikeda J, et al. Unfractionated heparin versus nafamostat mesylate for anticoagulation during continuous kidney replacement therapy[J]. BMC Nephrol, 2023, 24(1): 12.
[30] Miyaji MJ, Ide K, Takashima K, et al. Comparison of nafamostat mesilate to citrate anticoagulation in pediatric continuous kidney replacement therapy[J]. Pediatr Nephrol, 2022, 37(11): 2733-2742.
[31] Shioya N, Inoue N, Sato H, et al. Cardiopulmonary arrest caused by nafamostat mesylate during hemodialysis[J]. Clin Case Rep, 2022, 10(7): e6140.
Options
Outlines

/

〈 〉