Application of local citrate anticoagulation and heparin-free dialysis in hemodialysis of patients with high risk of bleeding tendency_West China Medical Journal

Authors：

LIU Sinan ¹ ,  CHEN Lin ¹ , CAO Xiaoyi ²

1. Hemodialysis Center of Nephrology Department, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Continuing Education Section, Nursing Department, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

CHEN Lin, Email: hxxuetou@163.com

Keywords：

Hemodialysis; Citrate; Effectiveness; Safety

DOI：

10.7507/1002-0179.201906040

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Objective To evaluate the safety and efficacy of local sodium citrate anticoagulation for routine hemodialysis in high-risk patients with hemorrhage.Methods A total of 150 patients who were admitted to West China Hospital from October 2018 to March 2019 for routine hemodialysis treatment with high-risk bleeding were selected as study objects. The patients were divided into without heparin anticoagulation group (group A) and with 4% sodium citrate anticoagulation group (group B) by random number table method, with 75 cases in each group. Biochemical indicators, serum calcium ion concentration, local anticoagulation safety index of citrate and dialysis adequacy index, blood coagulation in dialyzer and tube during dialysis wre observed in the two groups.Results The coagulation events in group B were significantly lower than those in group A (Z=–4.889, P<0.001), and the urea clearance index in group B was higher than that in group A [(1.26±0.12) vs. (0.73±0.13) L/(min·1.73 m²); t=22.418, P<0.05]. There was a significant difference in the changes of urea nitrogen [(3.53±1.05) vs.(3.12±1.11) mmol/L; t=2.323, P=0.021] 24 hours after dialysis; other indicators showed no statistically significant difference (P>0.05). After the filter, serum calcium ion concentrations in group B at different time points were lower than those in group A [2 hours: (0.52±0.07) vs. (0.64±0.08) mmol/L; 4 hours: (0.56±0.09) vs.(0.63±0.09) mmol/L; t=5.198, 0.525, P<0.001], and the coagulation time was higher in group B than that in group A [2 hours: (172.56±14.78) vs. (151.45±19.81) s; 4 hours: (168.45±16.48) vs. (152.88±16.54) s; t=7.396, 5.775, P<0.001]. None of the patients had dialysis-related adverse events.Conclusion Four percent sodium citrate is effective and safe in anticoagulation therapy for hemodialysis patients, and it can reduce the risk of coagulation in dialyzer and ensure the adequacy of maintenance hemodialysis.

Citation： LIU Sinan, CHEN Lin, CAO Xiaoyi. Application of local citrate anticoagulation and heparin-free dialysis in hemodialysis of patients with high risk of bleeding tendency. West China Medical Journal, 2019, 34(8): 928-932. doi: 10.7507/1002-0179.201906040 Copy

1.	趙筱娟, 李紅莉, 安文軍. 血液透析過程中局部枸櫞酸鈉抗凝和普通肝素抗凝的臨床隨機對照研究. 實用藥物與臨床, 2018, 21(3): 279-282.
2.	Krishnamurthy S, Yun YS. Recovery of microbially synthesized gold nanoparticles using sodium citrate and detergents. Chem Eng J, 2013, 214: 253-261.
3.	朱淑華, 樊蓉, 徐斌, 等. 簡化枸櫞酸抗凝無肝素透析的療效觀察. 腎臟病與透析腎移植雜志, 2017, 26(4): 323-327.
4.	李莉, 陸林, 樊蓉. 局部枸櫞酸抗凝在無肝素血液透析治療中的應用及護理. 東南國防醫藥, 2015, 28(6): 666-668.
5.	王婷立, 張凌, 陳志文, 等. 枸櫞酸抗凝在持續緩慢低效血液透析中的應用. 中華內科雜志, 2014, 53(12): 953-956.
6.	王奎, 楊定平. 局部枸櫞酸抗凝在高危出血風險血液透析患者中的應用. 臨床腎臟病雜志, 2018, 18(1): 17-20.
7.	王文琰, 趙非, 陳秋霞, 等. 枸櫞酸局部抗凝在尿毒癥兒童維持性血液透析中的應用. 南京醫科大學學報(自然科學版), 2018, 38(11): 1615-1618, 1647.
8.	Lifson ML, Levey CG, Gibson UJ. Diameter and location control of ZnO nanowires using electrodeposition and sodium citrate. Appl Phys A Mater Sci Process, 2013, 113(1): 243-247.
9.	吳青, 陳新, 周小華, 等. 不同抗凝方式對急性腎損傷患者持續性腎臟替代治療的療效比較. 中國藥業, 2018, 27(1): 64-66.
10.	于海鷹, 李松, 畢桂玲. 血液透析中局部枸櫞酸與小劑量低分子肝素抗凝的聯合應用分析. 中國醫藥導刊, 2016, 18(6): 618-620.
11.	Mehrizi S, Sohi MH, Saremi M. Effect of sodium citrate as complexing on electrochemical behavior and speciation diagrams of CoFeNiCu baths. Ionics (Kiel), 2013, 19(6): 911-918.
12.	徐志堅, 李桂蘭, 林瑛, 等. 低濃度枸櫞酸鹽局部抗凝技術對改善高危出血傾向行CRRT治療的療效分析. 浙江臨床醫學, 2016, 18(8): 1432-1433, 1440.
13.	Yin Y, Xu BL, Li Z, et al. Enhanced production of (+)-terrein in fed-batch cultivation of aspergillus terreus strain PF26 with sodium citrate. World J Microbiol Biotechnol, 2013, 29(3): 441-446.
14.	Jung MW, Kang SK, Lee JH. Effects of sodium citrate concentration on electroless Ni-Fe Bath stability and deposition. J Electronic Mater, 2014, 43(1): 290-298.
15.	Zafarani-Moattar MT, Jafari P. Phase diagrams for liquid-liquid and liquid-solid equilibrium of the ternary polyethylene glycol+di-sodium hydrogen citrate+water system. Fluid Phase Equilib, 2013, 337(15): 224-233.
16.	唐琦, 張黎明, 鄔碧波, 等. 局部枸櫞酸體外抗凝、低分子量肝素和無肝素抗凝對高危出血傾向患者行血液透析的療效和安全性. 上海醫學, 2007, 30(12): 898-901.
17.	Kannan R, Ganesan S, Selvakumari TM. An investigation on effects of annealing on magnetic properties of Ni-Fe-W-S electrodeposited coatings in tri Sodium citrate Bath. Iran J Sci Technol, 2013, 37(2): 181-187.
18.	Wang Y, Wang D, Wei G, et al. Improved co-production of S-adenosylmethionine and glutathione using citrate as an auxiliary energy substrate. Bioresour Technol, 2013, 131(12): 28-32.
19.	Lim EK, Seow YT, Chen SE, et al. Simple citrate anticoagulation protocol for low flux haemodialysis. BMC Nephrol, 2018, 19(1): 16.

1. 趙筱娟, 李紅莉, 安文軍. 血液透析過程中局部枸櫞酸鈉抗凝和普通肝素抗凝的臨床隨機對照研究. 實用藥物與臨床, 2018, 21(3): 279-282.
2. Krishnamurthy S, Yun YS. Recovery of microbially synthesized gold nanoparticles using sodium citrate and detergents. Chem Eng J, 2013, 214: 253-261.
3. 朱淑華, 樊蓉, 徐斌, 等. 簡化枸櫞酸抗凝無肝素透析的療效觀察. 腎臟病與透析腎移植雜志, 2017, 26(4): 323-327.
4. 李莉, 陸林, 樊蓉. 局部枸櫞酸抗凝在無肝素血液透析治療中的應用及護理. 東南國防醫藥, 2015, 28(6): 666-668.
5. 王婷立, 張凌, 陳志文, 等. 枸櫞酸抗凝在持續緩慢低效血液透析中的應用. 中華內科雜志, 2014, 53(12): 953-956.
6. 王奎, 楊定平. 局部枸櫞酸抗凝在高危出血風險血液透析患者中的應用. 臨床腎臟病雜志, 2018, 18(1): 17-20.
7. 王文琰, 趙非, 陳秋霞, 等. 枸櫞酸局部抗凝在尿毒癥兒童維持性血液透析中的應用. 南京醫科大學學報(自然科學版), 2018, 38(11): 1615-1618, 1647.
8. Lifson ML, Levey CG, Gibson UJ. Diameter and location control of ZnO nanowires using electrodeposition and sodium citrate. Appl Phys A Mater Sci Process, 2013, 113(1): 243-247.
9. 吳青, 陳新, 周小華, 等. 不同抗凝方式對急性腎損傷患者持續性腎臟替代治療的療效比較. 中國藥業, 2018, 27(1): 64-66.
10. 于海鷹, 李松, 畢桂玲. 血液透析中局部枸櫞酸與小劑量低分子肝素抗凝的聯合應用分析. 中國醫藥導刊, 2016, 18(6): 618-620.
11. Mehrizi S, Sohi MH, Saremi M. Effect of sodium citrate as complexing on electrochemical behavior and speciation diagrams of CoFeNiCu baths. Ionics (Kiel), 2013, 19(6): 911-918.
12. 徐志堅, 李桂蘭, 林瑛, 等. 低濃度枸櫞酸鹽局部抗凝技術對改善高危出血傾向行CRRT治療的療效分析. 浙江臨床醫學, 2016, 18(8): 1432-1433, 1440.
13. Yin Y, Xu BL, Li Z, et al. Enhanced production of (+)-terrein in fed-batch cultivation of aspergillus terreus strain PF26 with sodium citrate. World J Microbiol Biotechnol, 2013, 29(3): 441-446.
14. Jung MW, Kang SK, Lee JH. Effects of sodium citrate concentration on electroless Ni-Fe Bath stability and deposition. J Electronic Mater, 2014, 43(1): 290-298.
15. Zafarani-Moattar MT, Jafari P. Phase diagrams for liquid-liquid and liquid-solid equilibrium of the ternary polyethylene glycol+di-sodium hydrogen citrate+water system. Fluid Phase Equilib, 2013, 337(15): 224-233.
16. 唐琦, 張黎明, 鄔碧波, 等. 局部枸櫞酸體外抗凝、低分子量肝素和無肝素抗凝對高危出血傾向患者行血液透析的療效和安全性. 上海醫學, 2007, 30(12): 898-901.
17. Kannan R, Ganesan S, Selvakumari TM. An investigation on effects of annealing on magnetic properties of Ni-Fe-W-S electrodeposited coatings in tri Sodium citrate Bath. Iran J Sci Technol, 2013, 37(2): 181-187.
18. Wang Y, Wang D, Wei G, et al. Improved co-production of S-adenosylmethionine and glutathione using citrate as an auxiliary energy substrate. Bioresour Technol, 2013, 131(12): 28-32.
19. Lim EK, Seow YT, Chen SE, et al. Simple citrate anticoagulation protocol for low flux haemodialysis. BMC Nephrol, 2018, 19(1): 16.

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