Buturović-Ponikvar Jadranka, Gubensek Jakob, Ponikvar Rafael
Department of Nephrology, University Medical Center Ljubljana, University of Ljubljana, Ljubljana, Slovenia.
Ther Apher Dial. 2005 Jun;9(3):237-40. doi: 10.1111/j.1774-9987.2005.00262.x.
Single-needle hemodialysis can be the only option in some patients and requires full heparinization. The aim of our retrospective clinical study was to evaluate the safety and efficacy of regional citrate anticoagulation for single-needle hemodialysis. Citrate anticoagulation was performed during 41 single-needle hemodialysis procedures in 24 patients at risk of bleeding, using 4% trisodium citrate, 1 M CaCl2 and calcium-free dialysate. Safety was assessed by the percentage of procedures that were terminated prematurely or changed to another modality due to citrate-related complications and by incidence of important hypocalcemia. Efficacy was evaluated by visually assessing clot formation in the circuit. Five per cent of the procedures were terminated prematurely. Important hypocalcemia was recorded in 34% of the procedures. Anticoagulation was suboptimal in 17% of the procedures, but none of the systems clotted. The median dialyzer assessment grade was excellent. The average protocol parameters were: blood flow 244 +/- 27 mL/min, starting rate of citrate 191 +/- 19 mL/h, starting rate of calcium 6.7 +/- 1.1 mL/h. In the first hour, ionized calcium decreased in 67% of the procedures by 0.08 +/- 0.05 mmol/L. During the entire procedure, ionized calcium decreased in 80% of the cases by 0.17 +/- 0.09 mmol/L. There was a significant, but small increase in sodium (135 +/- 4 vs 137 +/- 4 mmol/L) and no increase in bicarbonate. Citrate anticoagulation during single-needle hemodialysis, according to our protocol, is safe and effective. Close monitoring of ionized calcium is mandatory. The calcium infusion rate should frequently be increased to correct hypocalcemia. The increased starting rate of calcium should be evaluated.
单针血液透析在某些患者中可能是唯一的选择，且需要充分肝素化。我们这项回顾性临床研究的目的是评估局部枸橼酸盐抗凝用于单针血液透析的安全性和有效性。在24例有出血风险的患者进行的41次单针血液透析过程中，使用4%枸橼酸钠、1M氯化钙和无钙透析液进行枸橼酸盐抗凝。通过因枸橼酸盐相关并发症而提前终止或改为其他方式的操作百分比以及严重低钙血症的发生率来评估安全性。通过直观评估回路中血栓形成来评估有效性。5%的操作提前终止。34%的操作记录到严重低钙血症。17%的操作抗凝效果欠佳，但没有一个系统发生凝血。透析器评估等级中位数为优秀。平均方案参数为：血流量244±27 mL/分钟，枸橼酸盐起始速率191±19 mL/小时，钙起始速率6.7±1.1 mL/小时。在第一个小时内，67%的操作中离子钙降低了0.08±0.05 mmol/L。在整个操作过程中，80%的病例中离子钙降低了0.17±0.09 mmol/L。钠有显著但微小的升高（135±4对比137±4 mmol/L），碳酸氢盐没有升高。根据我们的方案，单针血液透析期间的枸橼酸盐抗凝是安全有效的。必须密切监测离子钙。应频繁增加钙输注速率以纠正低钙血症。应评估增加的钙起始速率。
