Therapeutic Effect Of Regional Citrate Anticoagulation On Hemodialysis

Background:In recent years,the incidence of chronic kidney disease（CKD）is on the rise,and the therapeutic effect and prognosis are poor.Hemodialysis（HD）is the main treatment method for patients with end-stage renal disease（ESRD）.The key to ensuring blood purification treatment:anticoagulation is becoming more important.At present,unfractionated heparin（UFH）or low molecular weight heparin（LMWH）as the initial anticoagulant choice is very common.However,for patients with high-risk bleeding tendency or perioperative period,conventional anticoagulation will inevitably aggravate bleeding.However,heparin-free can not effectively avoid coagulation in extracorporeal circulation（ECC）pipeline,and the ideal dialysis effect is often not achieved.Regional citrate anticoagulation（RCA）is recognized as an ideal alternative anticoagulation method because it won’t affect the coagulation function of the whole body.It can be used in patients with high-risk bleeding tendency and effectively prevent bleeding and other complications,and is recognized as an ideal alternative anticoagulant method.Objective:This experiment explored a new regimen of RCA technology in maintenance hemodialysis for patients with high risk of bleeding,extended the treatment time,reduced biological adverse reactions,and provided more safe and effective treatment for patients.Methods:In total 41 patient,272 cases were divide into three groups:simplify-regional citrate anticoagulation（S-RCA）group,divide-regional citrate anticoagulation（D-RCA）group and heparin-free（HF）group.There were 66 cases in S-RCA group,58 cases in D-RCA group and 148 cases in HF group.The results of blood gas analysis during dialysis were recorded,and the supplementation of calcium dosage was determined according to the level of ionic calcium in blood gas.The time of dialysis,the incidence of hypocalcemia,the difference of ionic calcium before and after treatment,blood calcium,blood sodium,PH value,HCO3-and other indexes were recorded.The anticoagulant effect was observed and recorded,and the grade of dialyzer and blood vessel coagulation was recorded.Result:1.Among the 41 patients,27 were males and 14 were females,ranging in age from36 to 83 years,with an average age of 62.41±12.42 years.Among them,22 patients were randomly treated with two kinds of citric anticoagulation therapy.A total of 66 cases of dialysis were included in the S-RCA group,and 58 cases of dialysis were included in the D-RCA group.A total of 19 patients were enrolled in the HF group,and a total of 148 HF dialysis cases were included.There was no significant difference in sex,age,electrolyte,blood routine and blood coagulation routine between the citrate anticoagulation group（including S-RCA group and D-RCA group）and HF group.2.The effective rate of venous ampulla anticoagulation in D-RCA group was higher than that in S-RCA group（P<0.05）and HF group（P<0.05）,and the anticoagulant effective rate of venous ampulla in S-RCA group was significantly higher than that in HF group（P<0.05）.The anticoagulant efficiency of filter in S-RCA group and D-RCA group was higher than that in HF group（P<0.05）,and the anticoagulant efficiency of filter in D-RCA group was lower than that in S-RCA group,but there was no significant difference between the two groups（P>0.05）.3.The rate of dialysis time reaching the standard in S-RCA group and D-RCA group treated with citrate anticoagulation was significantly higher than that in HF group（P<0.05）,and the dialysis time reaching standard rate in D-RCA group was significantly higher than that in S-RCA group（P<0.05）.4.The level of iCa²⁺after filter in D-RCA group was slightly higher than that in S-RCA group during dialysis,but there was no significant difference in iCa²⁺level between the two groups before and after dialysis（P>0.05）.There was no significant difference in the difference of iCa²⁺level between the two groups before and after dialysis（P>0.05）.There was no significant difference in the levels of iNa⁺,HCO3^-and PH between the two groups before and after dialysis and during dialysis（P>0.05）.Conclusion:1.Compared with HF regimen,S-RCA regimen is more suitable for patients with high-risk bleeding tendency,while D-RCA regimen can further improve the anticoagulation efficiency of venous ampulla and improve the anticoagulation treatment time.2.D-RCA regimen had no significant effect on blood calcium level,and it will not increase the incidence of hypocalcemia.No bleeding,metabolic acid-base imbalance,electrolyte disturbance and other complications occurred in all patients during dialysis and treatment,which proved the safety of D-RCA regimen.