Regional citrate anticoagulation in critically ill patients during continuous blood purification

Objectives To evaluate the safety and define the contraindication of regional citrate anticoagulation treatment on various critically ill patients being treated by continuous blood purification, who also had bleeding tendencies. Methods Forty critically ill patients being treated by continuous blood purification (CBP) were involved in this study. Due to their bleeding tendencies, regional citrate anticoagulation treatment was given to all of them. Those with hepatic function impairment (n=10) were classified as Group A, those with hypoxemia were classified as Group B (n=10), and the others as Group C (n=20). Blood samples were collected before treatment, and at 4, 12, 24, 36, and 48 hour intervals during CBP. These samples then were used arterial blood gas analysis, whole blood activated clotting time (WBACT) pre- and post-filter, and serum ionized calcium examination. Results WBACT pre-filter showed little fluctuant through the 48hr period of CBP, and WBACT post-filter showed obvious prolongation than that of the pre-filter (P<0.05) at all time points. Metabolic acidosis was found in Group A patients before CBP, and improved during CBP. Normal acid-base conditions of patients were disturbed and deteriorated in Group B during CBP, but not in Group C. Serum ionized calcium was maintained at a normal range during CBP in Group A and C patients, but declined significantly in Group B patients (vs. pre-treatment, P<0.05). Conclusions Regional citrate anticoagulation can be safely used in conjunction with CBP treatment for patients with hepatic function impairment , but may induce acidosis and a decline in serum ionized calcium when used with hypoxemic patients.

Application of regional citrate anticoagulation in patients at high risk of bleeding during intermittent hemodialysis:a prospective multicenter randomized controlled trial

Objective:Safe and effective anticoagulation is essential for hemodialysis patients who are at high risk of bleeding.The purpose of this trial is to evaluate the effectiveness and safety of two-stage regional citrate anticoagulation(RCA)combined with sequential anticoagulation and standard calcium-containing dialysate in intermittent hemodialysis(IHD)treatment.Methods:Patients at high risk of bleeding who underwent IHD from September 2019 to May 2021 were prospectively enrolled in 13 blood purification centers of nephrology departments,and were randomly divided into RCA group and saline flushing group.In the RCA group,0.04 g/mL sodium citrate was infused from the start of the dialysis line during blood draining and at the venous expansion chamber.The sodium citrate was stopped after 3 h of dialysis,which was changed to sequential dialysis without anticoagulant.The hazard ratios for coagulation were according to baseline.Results:A total of 159 patients and 208 sessions were enrolled,including RCA group(80 patients,110 sessions)and saline flushing group(79 patients,98 sessions).The incidence of severe coagulation events of extracorporeal circulation in the RCA group was significantly lower than that in the saline flushing group(3.64%vs.20.41%,P<0.001).The survival time of the filter pipeline in the RCA group was significantly longer than that in the saline flushing group((238.34±9.33)min vs.(221.73±34.10)min,P<0.001).The urea clearance index(Kt/V)in the RCA group was similar to that in the saline flushing group with no statistically significant difference(1.12±0.34 vs.1.08±0.34,P=0.41).Conclusions:Compared with saline flushing,the two-stage RCA combined with a sequential anticoagulation strategy significantly reduced extracorporeal circulation clotting events and prolonged the dialysis time without serious adverse events.

Comparative Analysis of the Effect of Local Citrate Anticoagulation and Non-anticoagulation in Extended Intermittent Renal Replacement Therapy(PIRRT)

Objective:To observe the anticoagulant effect of local citrate anticoagulation and non-anticoagulation in prolonged intermittent renal replacement therapy(PITTR).Methods:From October 2018 to October 2019,30 patients with a high risk of bleeding who received PIRRT treatment in our hospital were selected and divided into RCA group(citrate group)and control group(non-anticoagulant group),15 cases in each group.The anticoagulant efficiency,filter service life,coagulation function,and blood gas indexes were compared between the two groups.Results:(1)the anticoagulant effective rate of the RCA group was higher than that of the control group,and the use time of the filter was longer than that of the control group(P<0.05).(2)There was no significant difference in Pt and APTT between the two groups before and after treatment(P>0.05).(3)There was no significant difference in plasma calcium concentration between the two groups before treatment,4,6 and 8 h after treatment(P>0.05).(4)In the RCA group,the pH value and be valued at 4,6 and 8 h after treatment were higher than those before treatment,but they were in the normal range,and the difference was statistically significant(P<0.05).Conclusion:In the extended intermittent renal replacement therapy,the effect of local citrate anticoagulation is better than that of non-anticoagulant therapy,which can prolong the service life of the filter,and there are no adverse reactions such as prolonged coagulation time,hypocalcemia,and metabolic acid-base imbalance.