Nseir Vanessa, Rachas Antoine, Elias Michelle, Francois Hélène, Nnang Obada Erika, Lorenzo Hans Kristian, Charpentier Bernard, Durrbach Antoine, Beaudreuil Séverine
IFRNT, Department of Nephrology, Bicêtre Hospital, University of Paris-Sud, Le Kremlin-Bicêtre, France.
Blood Purif. 2017;44(1):60-65. doi: 10.1159/000456532. Epub 2017 Mar 3.
The optimal management of anticoagulation in hemodialyzed patients with a high risk of bleeding is controversial.
We compared premature termination of dialysis caused by clotting events between AN69ST membranes (G1) and 0.8 mmol/L citrate-enriched dialysate (G2). The number of sessions that had increased venous pressure (VP) and variations in urea-reduction ratio (URR) were analyzed.
Six hundred and two sessions were analyzed in 259 patients: 22.4% had sessions that ended prematurely (25% in G1 and 19.1% in G2, p = ns, OR 0.60 [0.34-1.08], p = 0.08). The increase in VP was lower in G2 (23 vs. 70, p < 0.001). URR was higher in G2 (0.56 vs. 0.60, p < 0.001).
Clotting events that led to the termination of dialysis were comparable in the 2 groups. However, UUR was better in G2, and the number of patients with increased VP in the sessions was lower in G2.
Our study compared the effects of the AN69ST membrane and citrate-enriched dialysate on clotting events during the dialysis of 259 patients with a high risk of bleeding. URR was significantly better and fewer cases of increased VP occurred in the citrate group compared to the AN69 ST group. No significant difference was observed regarding the need to prematurely terminate a dialysis session.
对于出血风险高的血液透析患者，抗凝的最佳管理存在争议。
我们比较了AN69ST膜（G1组）和0.8 mmol/L富柠檬酸盐透析液（G2组）因凝血事件导致的透析提前终止情况。分析了静脉压（VP）升高的透析次数以及尿素清除率（URR）的变化。
对259例患者的602次透析进行了分析：22.4%的透析提前结束（G1组为25%，G2组为19.1%，p = 无统计学意义，比值比0.60 [0.34 - 1.08]，p = 0.08）。G2组VP升高幅度较小（23对70，p < 0.001）。G2组URR较高（0.56对0.60，p < 0.001）。
两组中导致透析终止的凝血事件相当。然而，G2组的URR更好，且该组透析过程中VP升高的患者数量更少。
我们的研究比较了AN69ST膜和富柠檬酸盐透析液对259例出血风险高的患者透析期间凝血事件的影响。与AN69 ST组相比，柠檬酸盐组的URR明显更好，VP升高的病例更少。在透析提前终止的必要性方面未观察到显著差异。
