Molina Nuñez Manuel, de Alarcón Rosa, Roca Susana, Álvarez Gracia, Ros María Soledad, Jimeno Cristina, Bucalo Laura, Villegas Isabel, García María Ángeles
Blood Purif. 2015;39(1-3):181-187. doi: 10.1159/000371569.
A bicarbonate dialysate acidified with citrate (CD) has been reported to have local anticoagulant effect and improves biocompatibility. This study examines the effect of CD on dialysis efficiency, coagulation, acid-base status, electrolytes, and inflammation in patients in on-line hemodiafiltration (OL-HDF).
35 patients in OL-HDF were enrolled in a prospective, cross-over study for a 24-week period and two phases alternating CD and acetate dialysate fluid (AD). Parameters on study were predialysis levels of bicarbonate and ionic calcium, reactive C Protein (CRP), and beta-2 microglobulin (B2MG) and postdialysis levels of activated tromboplastine time, bicarbonate, and ionized calcium.
No significant differences in coagulation parameters, pH, and predialysis bicarbonate were found. The postdialysis bicarbonate and postdialysis calcium were lower with CD. Dialysis efficiency was greater with CD. Regarding inflammatory parameters, both CRP and B2MG were lower using CD.
The use of CD is safe and effective in OL-HDF, and it improves dialysis efficacy, postdialysis alkalosis, and inflammation.
据报道，用柠檬酸盐酸化的碳酸氢盐透析液（CD）具有局部抗凝作用，并能改善生物相容性。本研究探讨了CD对在线血液透析滤过（OL-HDF）患者透析效率、凝血、酸碱状态、电解质及炎症的影响。
35例OL-HDF患者纳入一项为期24周的前瞻性交叉研究，分为两个阶段，交替使用CD和醋酸盐透析液（AD）。研究参数包括透析前的碳酸氢盐、离子钙、反应性C蛋白（CRP）和β2微球蛋白（B2MG）水平，以及透析后的活化部分凝血活酶时间、碳酸氢盐和离子钙水平。
凝血参数、pH值和透析前碳酸氢盐水平无显著差异。使用CD时，透析后碳酸氢盐和透析后钙较低。使用CD时透析效率更高。关于炎症参数，使用CD时CRP和B2MG均较低。
在OL-HDF中使用CD是安全有效的，它可提高透析疗效、改善透析后碱中毒及炎症。
