采用两步酶法测定局部枸橼酸抗凝连续肾脏替代治疗患者生物体液中枸橼酸盐浓度。

Measurement of the Concentration of Citrate in Human Biofluids in Patients Undergoing Continuous Renal Replacement Therapy Using Regional Citrate Anticoagulation: Application of a Two-Step Enzymatic Assay.

机构信息

School of Medicine, Sunshine Coast Campus, Griffith University, Birtinya, Queensland, Australia,

Genecology Research Centre, School of Health and Sport Sciences, University of the Sunshine Coast, Maroochydore, Queensland, Australia.

出版信息

Blood Purif. 2021;50(6):848-856. doi: 10.1159/000513150. Epub 2021 Feb 5.

DOI:10.1159/000513150

PMID:33550280

Abstract

BACKGROUND

Continuous renal replacement therapy (CRRT) with regional citrate anticoagulation (RCA) is now commonly used to treat acute kidney injury in critically ill patients. The concentration of citrate is not routinely measured, with citrate accumulation and/or toxicity primarily assessed using surrogate measures.

OBJECTIVES

The aim of this study was to measure the concentration of citrate in plasma and ultrafiltrate in patients receiving CRRT with RCA using a modified commercial enzymatic assay.

METHODS

After meeting inclusion criteria, blood was sampled from 20 patients before, during, and after episodes of filtration. Using spectrophotometry, samples were tested for citrate concentration. Demographic and other clinical and biochemical data were also collected. Throughout, a 15 mmol/L solution of trisodium citrate was used as the prefilter anticoagulant. Results were analysed using STATA (v15.0) and presented as mean (SD), median (IQR), or simple proportion. Comparisons were made using either the Student t test or the Wilcoxon rank-sum test. Correlation was assessed using Pearson's r.

RESULTS

Twenty patients (17 males) were enrolled in the study. Mean (SD) age was 63.7 years (9.9). Median (IQR) ICU length of stay was 281 h (199, 422) with 85% undergoing intermittent positive pressure ventilation. Median APACHE 3 score was 95 (87, 117) with an overall 30% mortality rate. Median filtration time was 85 h (46, 149). No difference was found between pre- and post-filtration plasma citrate concentrations (79 µmol/L [50] vs. 71 µmol/L [42], p = 0.65). Mean citrate concentration during filtration was 508 µmol/L (221) with a maximum of 1,070 µmol/L. This was significantly higher than the pre/post levels (p < 0.001).

CONCLUSIONS

Plasma concentrations of citrate rose significantly during episodes of CRRT using RCA returning back to normal after cessation of treatment.

摘要

背景

连续肾脏替代疗法（CRRT）联合局部枸橼酸抗凝（RCA）目前常用于治疗重症患者的急性肾损伤。枸橼酸盐的浓度通常不进行常规检测，主要通过替代指标评估枸橼酸盐的蓄积和/或毒性。

目的

本研究旨在使用改良的商业酶法检测接受 RCA-CRRT 的患者的血浆和超滤液中枸橼酸盐的浓度。

方法

符合纳入标准的 20 例患者在发生滤过事件前后采集血液样本。采用分光光度法检测枸橼酸盐浓度。同时收集患者的人口统计学和其他临床及生化数据。整个过程中，均使用 15mmol/L 的 trisodium citrate 作为预滤器抗凝剂。采用 STATA（v15.0）进行数据分析，结果表示为均值（标准差）、中位数（四分位间距）或简单比例。使用 Student t 检验或 Wilcoxon 秩和检验进行比较。采用 Pearson's r 评估相关性。

结果

本研究共纳入 20 例患者（17 例男性）。患者的平均（标准差）年龄为 63.7 岁（9.9）。中位（四分位间距）ICU 住院时间为 281 小时（199，422），85%的患者接受间歇性正压通气。中位急性生理与慢性健康评分 3 分为 95 分（87，117），总体死亡率为 30%。中位滤过时间为 85 小时（46，149）。滤过前后的血浆枸橼酸盐浓度无差异（79µmol/L[50] vs. 71µmol/L[42]，p=0.65）。滤过期间的枸橼酸盐平均浓度为 508µmol/L（221），最高值为 1070µmol/L。这显著高于预滤和后滤水平（p<0.001）。