| Objective:Regional Citrate Anticoagulation（RCA）is increasingly being used in regular hemodialysis patients with active bleeding,but its promotion is limited due to its complicated process.At present,the use of citric acid in dialysis with dialysate containing calcium is not uniform.Some scholars have proposed a low dose of citrate anticoagulation program with good c which can reduce or even cancel measurement of blood gas.Some have adopted a high dose of citrate anticoagulation program,but frequent blood gas monitoring is needed.Therefore,the purpose of this study is to compare the efficacy and safety of two different doses of regional citrate anticoagulation.Methods:Maintenance hemodialysis（MHD）patients with active bleeding or high bleeding risk in the hemodialysis center of Sichuan provincial people’s hospital from April2019 to January 2020 were included in the study.The patients are randomly assigned to group A or group B by the system using a random code table.Group A received low-dose RCA（L-RCA）in hemodialysis for 3 times,followed by high-dose RCA（H-RCA）for 3 times.Group B received H-RCA project for 3 times,followed by L-RCA for 3 times.To observe the completion rate of preset time,the adverse reactions,the anticoagulant efficacy and the change of blood gas during dialysis.Results:There were 14 patients finished with 84 cases,and 42 cases in each group.1.The citrate speed of L-RCA group was[200.00（196.98,205.64）]ml/h,and H-RCA group was[260（258.92,261.79）]ml/h,P<0.01.The total amount of citrate in L-RCA group was[780.00（761.81,803.19）]ml,and H-RCA group was[1040.00（974.70,1031.97）]ml,P<0.01.The completion rate of L-RCA and H-RCA was（90.48%vs.88.10%,P=0.72）.The dialysis time of two groups was similar（3.86±0.24 vs.3.79±0.44h,P=0.22）.2.Adverse reactions:there were 3 cases of palpitation,and 3 cases of hypocalcemia after dialysis in H-RCA group,without hypotension,allergy,hemolysis and other symptoms.3.Anticoagulant efficacy:the coagulation degree of filter and venous pot was divided into 0-3 levels,and level 2 or below was defined effective.The anticoagulant efficacy was 97.62%in the L-RCA group and 95.24%in the H-RCA group（P=1.00）.The anticoagulation efficiency of venous pot in both group was 83.33%（P=1.00）.The dialyzer life of L-RCA and H-RCA was（3.86±0.24 vs.3.82±0.41h,P=0.57）.4.Changes in blood gas:in L-RCA group,pH was slightly increased after dialysis(7.434±0.047 vs.7.490±0.054,P=1.21×e-7),calcium decreased(1.16±0.12 vs.1.09±0.09mmol/L,P=2.2×10-5)and sodium increased(137.69±2.43 vs.138.89±1.41mmol/L,P=1.16×10-3).In H-RCA group,pH increased(7.429±0.054 vs.7.488±0.053,P=3×10-6),calcium decreased(1.15±0.12 vs.1.06±0.08mmol/L,P=4.9×10-5)and sodium increased 138.50（137.00,140.00）vs.139.00（138.00,141.00）,P=4.82×10-4.Mean changes in calcium after dialysis in L-RCA and H-RCA group was（-0.09±0.10 vs.-0.08±0.10mmol/L,P=0.896）and sodium（1.19±2.03 vs.1.14±1.75mmol/L,P=0.909）.After 2h dialysis progress,the calcium before venous pot of two group was（1.00±0.10 vs.0.96±0.09mmol/L,P=0.046）.Conclusion:1.There is no significant difference between L-RCA and H-RCA in the completion rate of preset time.2.The anticoagulation efficacy of L-RCA was not worse than H-RCA,and both groups have fewer adverse reaction.3.After dialysis,pH,Na+increased and calcium decreased.It is suggested that the concentration of bicarbonate could be reduced appropriately to avoid alkalosis.After dialysis,the sodium increasing was related to the large amount of trisodium citrate injected,it was suggested to adjust the concentration of sodium in dialysate according to the patient’s own conditions（such as blood pressure）. |
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