Morabito Santo, Pistolesi Valentina, Tritapepe Luigi, Fiaccadori Enrico
Department of Nephrology and Urology, Hemodialysis Unit and
Department of Nephrology and Urology, Hemodialysis Unit and.
Clin J Am Soc Nephrol. 2014 Dec 5;9(12):2173-88. doi: 10.2215/CJN.01280214. Epub 2014 Jul 3.
Hemorrhagic complications have been reported in up to 30% of critically ill patients with AKI undergoing RRT with systemic anticoagulation. Because bleeding is associated with significantly increased mortality risk, strategies aimed at reducing hemorrhagic complications while maintaining extracorporeal circulation should be implemented. Among the alternatives to systemic anticoagulation, regional citrate anticoagulation has been shown to prolong circuit life while reducing the incidence of hemorrhagic complications and lowering transfusion needs. For these reasons, the recently published Kidney Disease Improving Global Outcomes Clinical Practice Guidelines for Acute Kidney Injury have recommended regional citrate anticoagulation as the preferred anticoagulation modality for continuous RRT in critically ill patients in whom it is not contraindicated. However, the use of regional citrate anticoagulation is still limited because of concerns related to the risk of metabolic complications, the complexity of the proposed protocols, and the need for customized solutions. The introduction of simplified anticoagulation protocols based on citrate and the development of dialysis monitors with integrated infusion systems and dedicated software could lead to the wider use of regional citrate anticoagulation in upcoming years.
据报道，在接受全身抗凝的急性肾损伤（AKI）重症患者中，高达30%会出现出血并发症。由于出血与死亡风险显著增加相关，应实施旨在减少出血并发症同时维持体外循环的策略。在全身抗凝的替代方法中，局部枸橼酸盐抗凝已被证明可延长体外循环寿命，同时降低出血并发症的发生率并减少输血需求。基于这些原因，最近发布的《改善全球肾脏病预后组织急性肾损伤临床实践指南》推荐，对于无禁忌证的重症患者，局部枸橼酸盐抗凝是连续性肾脏替代治疗（RRT）的首选抗凝方式。然而，由于担心代谢并发症风险、所提议方案的复杂性以及对定制解决方案的需求，局部枸橼酸盐抗凝的使用仍然有限。基于枸橼酸盐的简化抗凝方案的引入以及具备集成输注系统和专用软件的透析监测器的开发，可能会在未来几年导致局部枸橼酸盐抗凝的更广泛应用。
