Department of Emergency Medicine and Intensive Care, Shanghai Songjiang Clinical Medical College of Nanjing Medical University, Shanghai, China.
Department of Biostatistics, Zhongshan Hospital, Fudan University, Shanghai, China.
Int J Artif Organs. 2021 Aug;44(8):551-559. doi: 10.1177/0391398820982620. Epub 2020 Dec 18.
Regional citrate anticoagulation (RCA) for renal replacement therapy is widely practiced in critically ill patients. However, concern exists regarding its labor-intensiveness for monitoring and the associated hypocalcemia. In this study, we provided an algorithm for prescribing RCA and evaluated its safety in patients.
During 18 hemofiltration treatments with calcium-free replacement solution, participants were randomized to receive algorithm-based or trial-and-error RCA protocol. The effluent volume, post-filter and in vivo ionized calcium (iCa), and calcium in the sera and effluents were periodically measured at an interval of 1 to 2 h.
For patients received algorithm-based RCA protocol, no one had a serum iCa less than 0.9 mmol/L, and none needed calcium supplement adjustment to maintain serum calcium stability. For patients accepted trial-and-error protocol, all patients had a serum iCa below 0.9 mmol/L, their serum iCa and calcium levels fluctuated dramatically, and all patients need additional calcium supplement adjustment during RCA. None of the participants showed a post-filter iCa > 0.4 mmol/L.
We provided a safe algorithm for calculating calcium supplementation doses that could maintain serum calcium stability without additional adjustment during RCA.
局部枸橼酸抗凝（RCA）在危重症患者中广泛应用于肾脏替代治疗。然而，其监测的复杂性和相关的低钙血症引起了关注。本研究提供了一种 RCA 用药方案，并评估了其在患者中的安全性。
在使用无钙替代溶液进行的 18 次血液滤过治疗中，参与者随机接受基于算法或经验性 RCA 方案。每 1-2 小时测量一次流出液体积、滤后和体内离子钙（iCa）以及血清和流出液中的钙。
对于接受基于算法的 RCA 方案的患者，没有人血清 iCa 低于 0.9mmol/L，且无需调整钙补充剂以维持血清钙稳定。对于接受经验性方案的患者，所有患者的血清 iCa 均低于 0.9mmol/L，其血清 iCa 和钙水平波动较大，所有患者在 RCA 期间均需要额外的钙补充调整。没有参与者出现滤后 iCa>0.4mmol/L。
我们提供了一种安全的算法，可以计算钙补充剂量，在 RCA 期间无需额外调整即可维持血清钙稳定。
