Davenport Andrew, Tolwani Ashita
UCL Center for Nephrology, Royal Free Campus , University College London Medical School , London , UK.
Division of Nephrology , University of Alabama at Birmingham , Birmingham, AL , USA.
NDT Plus. 2009 Dec;2(6):439-47. doi: 10.1093/ndtplus/sfp136. Epub 2009 Sep 25.
Continuous forms of renal replacement therapy (CRRT) have become established as the treatment of choice for supporting critically ill patients with acute kidney injury. Typically, these patients have activation of the coagulation cascades, peripheral mononuclear cells and platelets, but also a reduction in natural anticoagulants, and are therefore prothrombotic. For continuous modes of renal replacement therapy to be effective, in terms of both effective solute clearance and also fluid removal, the extracorporeal circuits must operate continuously. Thus, preventing clotting in the CRRT circuit is a key goal to effective patient management. As these patients may also be at increased risk of bleeding, regional anticoagulation with citrate is increasing in popularity, particularly following the introduction of commercially available CRRT machines and fluids specifically designed for citrate anticoagulation. Although regional anticoagulation with citrate provides many advantages over other systemic anticoagulants, excess citrate may lead to both metabolic complications, ranging from acidosis to alkalosis and may also potentially expose patients to electrolyte disturbances due to hyper- and hyponatraemia and hyper- and hypocalcaemia.
连续性肾脏替代治疗（CRRT）已成为治疗急性肾损伤危重症患者的首选方法。通常，这些患者的凝血级联反应、外周单核细胞和血小板被激活，同时天然抗凝物质减少，因此处于血栓形成前状态。为使连续性肾脏替代治疗有效，无论是在有效清除溶质还是在清除液体方面，体外循环都必须持续运行。因此，防止CRRT回路凝血是有效管理患者的关键目标。由于这些患者出血风险也可能增加，枸橼酸盐局部抗凝越来越受欢迎，尤其是在市售的专门为枸橼酸盐抗凝设计的CRRT机器和液体推出之后。尽管枸橼酸盐局部抗凝比其他全身抗凝剂具有许多优势，但过量的枸橼酸盐可能导致从酸中毒到碱中毒的各种代谢并发症，还可能因高钠血症、低钠血症、高钙血症和低钙血症而使患者面临电解质紊乱的风险。
