Buturovic-Ponikvar Jadranka
Department of Nephrology, University Medical Centre Ljubljana, Ljubljana, Slovenia.
Faculty of Medicine, University of Ljubljana, Slovenia.
Ther Apher Dial. 2016 Jun;20(3):234-9. doi: 10.1111/1744-9987.12429.
Citrate has many characteristics of the ideal anticoagulant for hemodialysis. In addition to immediate and complete anticoagulation in the dialysis circuit, citrate has important effects beyond anticoagulation, mainly in reducing inflammatory response induced by hemodialysis. Citrate has already become the standard anticoagulant in acute kidney injury requiring continuous renal replacement therapy (CRRT), both for adults and children, with the citrate module being a part of modern CRRT monitors. Although the citrate module is not yet available for intermittent hemodialysis, precise infusion pumps, point-of-care ionometers and high citrate clearance from high flux dialyzers increase safety while reducing the risk of metabolic complications, both in adult and pediatric patients. Slovenia has a long tradition, high volume and expansion of citrate use in hemodialysis, including long-term citrate anticoagulation in selected patients. At the Department of Nephrology, University Medical Centre Ljubljana, more than 10 000 citrate procedures were performed in 2015. We believe that regional citrate anticoagulation may replace heparin as the main anticoagulant for intermittent hemodialysis in the not so distant future.
枸橼酸盐具有许多作为血液透析理想抗凝剂的特性。除了能在透析回路中立即实现完全抗凝外，枸橼酸盐还具有抗凝以外的重要作用，主要是减少血液透析引起的炎症反应。枸橼酸盐已成为成人和儿童急性肾损伤需要持续肾脏替代治疗（CRRT）时的标准抗凝剂，枸橼酸盐模块是现代CRRT监测仪的一部分。尽管枸橼酸盐模块尚未用于间歇性血液透析，但精确的输液泵、即时离子计以及高通量透析器对枸橼酸盐的高清除率提高了安全性，同时降低了成人和儿童患者发生代谢并发症的风险。斯洛文尼亚在血液透析中使用枸橼酸盐有着悠久的传统、大量的应用以及不断的扩展，包括在特定患者中进行长期枸橼酸盐抗凝。在卢布尔雅那大学医学中心肾脏病科，2015年进行了超过10000例枸橼酸盐相关操作。我们相信，在不久的将来，区域性枸橼酸盐抗凝可能会取代肝素成为间歇性血液透析的主要抗凝剂。
