Nurmohamed S Azam, Vervloet Marc G, Girbes Armand R J, Ter Wee Pieter M, Groeneveld A B Johan
Department of Nephrology, VU University Medical Center, Amsterdam, The Netherlands.
Blood Purif. 2007;25(4):316-23. doi: 10.1159/000107045. Epub 2007 Aug 14.
BACKGROUND/AIMS: Continuous venovenous hemofiltration (CVVH) requires anticoagulation to prevent circuit clotting and its use is contraindicated in patients with high bleeding risk. The aim of this study was to compare CVVH with and without regional citrate anticoagulation (RCA) with respect to filter life, azotemic control and cost.
This was a prospective sequential cohort study. The first cohort of patients with a high bleeding risk and acute renal failure was treated by anticoagulant-free predilution CVVH (n = 31). In the second cohort, CVVH was applied with RCA (n = 20).
The median filter life was 41 h (interquartile range 20-62) with RCA and 12 h (8-28) without RCA (p = 0.001). The azotemic control was better in the group with RCA. The hourly cost was comparable between the two groups.
Regional anticoagulation with citrate-based replacement solution improved filter life compared to anticoagulant-free predilution CVVH. This regimen appeared safe, feasible and without metabolic complications or increased costs.
背景/目的：连续性静脉-静脉血液滤过（CVVH）需要抗凝以防止体外循环凝血，而高出血风险患者禁忌使用。本研究的目的是比较采用和不采用局部枸橼酸盐抗凝（RCA）的CVVH在滤器使用寿命、氮质血症控制及成本方面的差异。
这是一项前瞻性序贯队列研究。第一组为高出血风险且急性肾衰竭的患者，采用无抗凝剂前稀释CVVH治疗（n = 31）。第二组采用RCA进行CVVH治疗（n = 20）。
采用RCA时滤器使用寿命的中位数为41小时（四分位间距20 - 62），不采用RCA时为12小时（8 - 28）（p = 0.001）。RCA组的氮质血症控制更佳。两组的每小时成本相当。
与无抗凝剂前稀释CVVH相比，使用基于枸橼酸盐的置换液进行局部抗凝可延长滤器使用寿命。该方案似乎安全、可行，且无代谢并发症或成本增加。
