Morgera Stanislao, Scholle Cornelia, Melzer Christoph, Slowinski Torsten, Liefeld Lutz, Baumann Gerd, Peters Harm, Neumayer Hans-H
Department of Nephrology, Charité, Humboldt University of Berlin, Berlin, Germany.
Nephron Clin Pract. 2004;98(1):c35-40. doi: 10.1159/000079925.
The Genius dialysis system is a close loop dialysis batch system increasingly used as an intermittent hemodialysis device in intensive care units. The aim of this study was to test the safety and feasibility of a regional citrate anticoagulation protocol with respect to acid-base and electrolyte disarrangements in critically ill patients with acute renal failure. A standard heparin anticoagulation protocol served as control.
In a cross-over study design, 27 acute renal failure patients were allocated to a citrate- and heparin-anticoagulated dialysis sessions (4-6 h). For citrate anticoagulation, a 4% sodium-citrate solution was infused into the arterial line of the extracorporeal circuit. A low calcium dialysate (1 mmol/l) was used for all dialysis sessions. Citrate dosing was adjusted according to the post-filter ionized calcium concentration (targeted values 0.5-0.7 mmol/l). There was no routine calcium substitution. Heparin anticoagulation was started with a heparin-loading dose followed by an individual, patient-adjusted continuous heparin infusion. Electrolyte disarrangements, namely hypernatremia, hypo- and hypercalcemia did not occur in either group. Although the highest bicarbonate levels were achieved during citrate anticoagulation (p = 0.021 versus heparin) the acid base values remained equilibrated in both groups. Filter longevity was excellent and the targeted dialysis time was achieved in all but 1 patient. Citrate anticoagulation was well tolerated with respect to cardiovascular hemodynamics.
Citrate anticoagulation can be safely and effectively performed during intermittent Genius dialysis. Calcium supplementation is not routinely required.
Genius透析系统是一种闭环透析批处理系统，在重症监护病房越来越多地用作间歇性血液透析设备。本研究的目的是测试区域枸橼酸盐抗凝方案在急性肾衰竭重症患者中酸碱和电解质紊乱方面的安全性和可行性。采用标准肝素抗凝方案作为对照。
在一项交叉研究设计中，27例急性肾衰竭患者被分配到接受枸橼酸盐和肝素抗凝的透析疗程（4 - 6小时）。对于枸橼酸盐抗凝，将4%的枸橼酸钠溶液注入体外循环的动脉管路。所有透析疗程均使用低钙透析液（1 mmol/L）。根据滤器后离子钙浓度调整枸橼酸盐剂量（目标值0.5 - 0.7 mmol/L）。不进行常规补钙。肝素抗凝开始时给予肝素负荷剂量，随后根据患者个体情况调整持续肝素输注。两组均未发生电解质紊乱，即高钠血症、低钙血症和高钙血症。尽管在枸橼酸盐抗凝期间达到了最高的碳酸氢盐水平（与肝素相比，p = 0.021），但两组的酸碱值均保持平衡。滤器使用寿命良好，除1例患者外，所有患者均达到了目标透析时间。就心血管血流动力学而言，可以很好地耐受枸橼酸盐抗凝。
在间歇性Genius透析期间，可以安全有效地进行枸橼酸盐抗凝。通常不需要补钙。
Zotero 插件