Schneider M, Liefeldt L, Slowinski T, Peters H, Neumayer H-H, Morgera S
Department of Nephrology, Charité Campus Mitte, Charité University Hospital of Berlin, Berlin - Germany.
Int J Artif Organs. 2008 Jan;31(1):43-8. doi: 10.1177/039139880803100106.
The Genius dialysis system is increasingly used as an intermittent hemodialysis device in the setting of acute renal failure. Slow extended hemodialysis is preferred in the case of critical ill patients. In this study we established a safe and feasible citrate anticoagulation protocol for slow extended hemodialysis (SLED) with the Genius system.
We compared six anticoagulation protocols using SLED in 34 critically ill patients with acute renal failure. One group (A) received only citrate anticoagulation. Four groups (B - D) were treated with citrate and different additional systemic anticoagulation. Patients in the last group (F) were anticoagulated with heparin and were free of citrate anticoagulation. The total number of treatments was 103. A 4% sodium citrate solution was infused into the arterial line of the dialysis device for citrate anticoagulation. The dialysis solution contained one mmol/L of calcium. No additional calcium supplementation was done. We monitored electrolyte, acid-base and cardiovascular status prospectively.
Hemodialysis was well tolerated hemodynamically. Electrolytes remained stable throughout hemodialysis in all groups. The decrease in ionized and total calcium was within the expected, clinically acceptable range. Bicarbonate and pH levels increased during dialysis, especially if citrate was used.
Slow extended Genius hemodialysis with citrate is well tolerated and offers a safe and effective alternative to systemic anticoagulation.
Genius透析系统越来越多地被用作急性肾衰竭情况下的间歇性血液透析设备。对于危重症患者，缓慢延长血液透析更为可取。在本研究中，我们为使用Genius系统进行缓慢延长血液透析（SLED）建立了一种安全可行的枸橼酸盐抗凝方案。
我们比较了34例急性肾衰竭危重症患者使用SLED的六种抗凝方案。一组（A组）仅接受枸橼酸盐抗凝。四组（B - D组）接受枸橼酸盐和不同的额外全身抗凝治疗。最后一组（F组）患者用肝素抗凝且未使用枸橼酸盐抗凝。治疗总数为103次。将4%的枸橼酸钠溶液注入透析设备的动脉管路进行枸橼酸盐抗凝。透析液含有1 mmol/L的钙。未进行额外的钙补充。我们前瞻性地监测电解质、酸碱和心血管状态。
血液透析在血流动力学上耐受性良好。所有组在血液透析过程中电解质均保持稳定。离子钙和总钙的降低在预期的、临床可接受的范围内。透析期间碳酸氢盐和pH值升高，尤其是使用枸橼酸盐时。
枸橼酸盐缓慢延长Genius血液透析耐受性良好，为全身抗凝提供了一种安全有效的替代方法。
