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

Xiaoyan Tang, Dezheng Chen, Ling Zhang, Ping Fu, Yanxia Chen, Zhou Xiao, Xiangcheng Xiao, Weisheng Peng, Li Cheng, Yanmin Zhang, Hongbo Li, Kehui Li, Bizhen Gou, Xin Wu, Qian Yu, Lijun Jian, Zaizhi Zhu, Yu Wen, Cheng Liu, Hen Xue, Hongyu Zhang, Xin He, Bin Yan, Liping Zhong, Bin Huang, Mingying Mao
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引用次数: 2

Abstract

Objectives: 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.

局部柠檬酸盐抗凝在间歇性血液透析中出血高危患者中的应用:一项前瞻性多中心随机对照试验
目的:安全有效的抗凝治疗对高危出血血液透析患者至关重要。本试验的目的是评估两期局部柠檬酸抗凝(RCA)联合序贯抗凝和标准含钙透析液在间歇性血液透析(IHD)治疗中的有效性和安全性。方法:前瞻性纳入2019年9月至2021年5月在13家肾内科血液净化中心行IHD的高危出血患者,随机分为RCA组和生理盐水冲洗组。在RCA组中,在透析线起始处和静脉扩张室处,在血液引流时输注0.04 g/mL柠檬酸钠。透析3 h后停用柠檬酸钠,改为序贯透析,不使用抗凝剂。凝血的危险比与基线一致。结果:共纳入159例患者,208个疗程,包括RCA组(80例患者,110个疗程)和生理盐水冲洗组(79例患者,98个疗程)。RCA组体外循环严重凝血事件发生率显著低于生理盐水冲洗组(3.64%∶20.41%,PPKt/V), RCA组与生理盐水冲洗组相似,差异无统计学意义(1.12±0.34∶1.08±0.34,P=0.41)。结论:与生理盐水冲洗相比,两期RCA联合序贯抗凝策略可显著减少体外循环凝血事件,延长透析时间,无严重不良事件发生。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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