Leung Kelvin C W, Tai Davina J, Ravani Pietro, Quinn Rob R, Scott-Douglas Nairne, MacRae Jennifer M
Cumming School of Medicine, University of Calgary.
Cumming School of Medicine, University of Saskatchewan.
Hemodial Int. 2016 Oct;20(4):537-547. doi: 10.1111/hdi.12433. Epub 2016 Jun 20.
Introduction Citrate containing dialysate has a calcium-binding anticoagulant effect compared to standard acetic acid containing dialysate. We performed a randomized, double-blind, crossover trial in maintenance HD patients to determine if citrate dialysate ("citrate") safely allows for a lower cumulative heparin dose ("heparin dose"). Methods Intradialytic heparin was adjusted to the minimum during a 2-week run-in phase. Patients remaining on heparin at the end of the run-in phase were then randomized to two weeks of HD with acetate dialysate ("acetate") followed by two weeks of citrate (sequence 1) or two weeks of citrate followed by two weeks of acetate (sequence 2). We estimated a minimum of 14 patients are required to show a 30% reduction in heparin dose per HD session with citrate compared with acetate. Twenty-five patients entered the run-in phase, 20 were randomized, and 19 completed the study. Findings The mean heparin dose was reduced by 19% (656 units, 95% CI -174 to -1139 units, P = 0.011) in the acetate group, and 30% (1046 units 95% CI -498 to 1594 units, P < 0.001) in the citrate group. There was no difference in the mean heparin dose reduction between the two dialysates (P > 0.05). The intradialytic ionized calcium in the citrate group was lowered by 0.10 mmol/L (95% CI 0.07 to 0.14 mmol/L, P < 0.001), and remained unchanged in the acetate group. Discussion Although citrate is a safe alternative to acetate, it does not result in additional heparin dose reduction.
与标准的含醋酸盐透析液相比，含柠檬酸盐的透析液具有钙结合抗凝作用。我们在维持性血液透析（HD）患者中进行了一项随机、双盲、交叉试验，以确定柠檬酸盐透析液（“柠檬酸盐”）是否能安全地降低累积肝素剂量（“肝素剂量”）。方法：在为期2周的导入期内，将透析过程中的肝素剂量调整至最低。在导入期结束时仍使用肝素的患者，随后被随机分为接受两周醋酸盐透析液（“醋酸盐”）透析，接着两周柠檬酸盐透析（顺序1），或两周柠檬酸盐透析，接着两周醋酸盐透析（顺序2）。我们估计，至少需要14名患者才能显示与醋酸盐相比，使用柠檬酸盐时每次HD治疗的肝素剂量降低30%。25名患者进入导入期，20名被随机分组，19名完成了研究。结果：醋酸盐组的平均肝素剂量降低了19%（656单位，95%可信区间-174至-1139单位，P = 0.011），柠檬酸盐组降低了30%（1046单位，95%可信区间-498至1594单位，P < 0.001）。两种透析液之间的平均肝素剂量降低没有差异（P > 0.05）。柠檬酸盐组透析过程中的离子钙降低了0.10 mmol/L（95%可信区间0.07至0.14 mmol/L，P < 0.001），醋酸盐组则保持不变。讨论：尽管柠檬酸盐是醋酸盐的安全替代品，但它并不会额外降低肝素剂量。
