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

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Journal of Zhejiang University-Science B(Biomedicine & Biotechnology) 2022年第11期23卷 931-942页

作者： 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 Division of Nephrology Kidney Research InstituteWest China Hospital of Sichuan UniversityChengdu 610041China Department of Nephrology People's Hospital of Jianyang CityChengdu64140China Department of Nephrology the Second Afiliated Hospital of Nanchang UniversityNanchang 330006China Department of Nephrology Xiangya Hospital of Central SouthUniversityChangsha 410008China Department of Nephrology Wuhan No.1HospitalWuhan 430022China Department of Blood Purification the First Affliated Hospital of Guangxi Medical UniversityNanning 530021China Department of Nephrology GuiyangFirst People's HospitalGuiyang550002China Department of Nephrology West China Hospital Sichuan University Jintang HospitalJintang 610400China Department of Nephrology Meishan People's HospitalMeishan 620020China Department of Nephrology Ziyang People's Hospital.Ziyang 641300China Department of Nephrology Ya'an People's HospitalYan 625000China Department of Nephrology Chengdu Kangfu Kidney Disease HospitalChengdu 610047China Department of Nephrology the First People's Hospital of Liangshan Yi Autonomous PrefectureXichang 615000China

Objective:Safe and effective anticoagulation is essential for hemodialysis patients who are at high risk of *** 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)***: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 *** 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 *** sodium citrate was stopped after 3 h of dialysis,which was changed to sequential dialysis without *** hazard ratios for coagulation were according to ***: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.

关键词： Regional citrate anticoagulation Intermittent hemodialysis calcium-containing dialysate Saline flushing Anticoagulation

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