血液透析患者国际标准化比值监测采样方法的比较（INRHaemo 研究）。

Comparison of Sampling Methods for International Normalized Ratio Monitoring in Haemodialysis Patients (INRHaemo Study).

机构信息

Department of Medicine, Campbelltown Hospital, Campbelltown, New South Wales, Australia,

Renal Department, Liverpool Hospital, Liverpool, New South Wales, Australia.

出版信息

Am J Nephrol. 2021;52(1):17-25. doi: 10.1159/000513094. Epub 2021 Feb 8.

DOI:10.1159/000513094

PMID:33556938

Abstract

BACKGROUND

Haemorrhagic and thrombotic complications are common in dialysis patients on warfarin; thus, accurate international normalized ratio (INR) monitoring is critical. For expediency and patient comfort, blood sampling from the haemodialysis access or circuit is commonly performed. Point-of-care (POC) INR machines allow both peripheral vein preservation and rapid results, yet are not validated in the haemodialysis population.

METHODS

A prospective cohort study in haemodialysis patients taking warfarin was undertaken. Three paired samples were drawn over a single session: peripheral blood INR, POC INR, and dialysis INR. Agreement using Bland-Altman analysis and correlation coefficients between the peripheral blood INR, haemodialysis INR, and POC INR were calculated. Inappropriate dosing decisions based on haemodialysis or POC INR were quantified.

RESULTS

Amongst 34 patients, agreement between the dialysis INR and peripheral blood INR was high, with the haemodialysis INR differing from the peripheral INR by <±0.2, 85.2% of the time. Correlation between the 2 methods was high (r = 0.914; p < 0.001). POC INR differed from peripheral INR values by <±0.2, 67.6% of the time, with less agreement at higher INR values. Dosing decisions were incongruent between the dialysis and peripheral INR in 6%, whilst the POC and peripheral INR disagreed in 26%.

CONCLUSIONS

There was good agreement and correlation between the peripheral blood, haemodialysis access/circuit, and POC INR values. POC INR was less reliable at higher values, and dosing decisions differed from the peripheral INR in a quarter of cases.

摘要

背景

在服用华法林的透析患者中，出血和血栓并发症很常见；因此，准确监测国际标准化比值（INR）至关重要。为了方便和患者舒适，通常从血液透析通路或回路中采集血液样本。即时检测（POC）INR 仪器既能保留外周静脉，又能快速得出结果，但尚未在血液透析人群中得到验证。

方法

对服用华法林的血液透析患者进行了前瞻性队列研究。在单次透析过程中采集了 3 对样本：外周血 INR、POC INR 和透析 INR。使用 Bland-Altman 分析和外周血 INR、血液透析 INR 和 POC INR 之间的相关系数来计算一致性。根据血液透析或 POC INR 进行的不适当剂量决策进行了量化。

结果

在 34 名患者中，透析 INR 与外周血 INR 的一致性很高，透析 INR 与外周 INR 的差值<±0.2 的情况占 85.2%。两种方法之间的相关性很高（r=0.914；p<0.001）。POC INR 与外周 INR 值的差值<±0.2 的情况占 67.6%，在 INR 值较高时一致性较差。在 6%的情况下，透析和外周 INR 之间的剂量决策不一致，而 POC 和外周 INR 之间的不一致则占 26%。