Department of Medicine, University of California, San Diego, La Jolla, California; Department of Internal Medicine, Pusan National University School of Medicine, Pusan, Republic of Korea.
Department of Medicine, University of California, San Diego, La Jolla, California.
Am J Kidney Dis. 2021 Oct;78(4):550-559.e1. doi: 10.1053/j.ajkd.2021.01.017. Epub 2021 Mar 30.
Regional citrate anticoagulation (RCA) is the preferred anticoagulation method for continuous kidney replacement therapy (CKRT) recommended by KDIGO. Limited availability of calcium-free solutions often imposes challenges to the implementation of RCA for CKRT (RCA-CKRT). The principal purpose of this study was to characterize the outcomes of RCA-CKRT using calcium-containing solutions.
Retrospective cohort study.
SETTING & PARTICIPANTS: We evaluated the safety and efficacy of RCA-CKRT with calcium-containing dialysate and replacement fluid used for 128 patients. A total of 571 filters and 1,227 days of CKRT were analyzed.
Liver disease, sepsis in the absence of liver disease, and sepsis with liver disease.
Filter life and metabolic complications per 100 CKRT days.
Linear mixed-effects model and generalized linear mixed-effects models.
The majority of patients were male (91; 71.1%), 32 (25%) had liver disease, and 29 (22.7%) had sepsis without liver disease. Median filter life was 50.0 (interquartile range, 22.0-118.0) hours, with a maximum of 322 hours, and was significantly lower (33.5 [interquartile range, 17.5-60.5] h) in patients with liver disease. Calcium-containing replacement solutions were used in 41.6% of all CKRT hours and reduced intravenous calcium requirements by 31.7%. Hypocalcemia (ionized calcium<0.85mmol/L) and hypercalcemia (total calcium>10.6mg/dL) were observed in 6.0 and 6.7 per 100 CKRT days, respectively. Citrate accumulation was observed in 13.3% of all patients and was associated with metabolic acidosis in 3.9%, which was not significantly different in patients with liver disease (9.3%; P = 0.2).
Lack of control groups that used calcium-free dialysate and replacement solutions with RCA-CKRT. Possible overestimation of filter life from incomplete data on cause of filter failure.
Our study suggests that RCA-CKRT with calcium-containing solutions is feasible and safe in critically ill patients, including those with sepsis and liver disease.
局部枸橼酸抗凝（RCA）是 KDIGO 推荐的连续肾脏替代治疗（CKRT）的首选抗凝方法。由于缺乏无钙溶液，RCA 在 CKRT 中的应用（RCA-CKRT）常面临挑战。本研究的主要目的是描述使用含钙溶液进行 RCA-CKRT 的结果。
回顾性队列研究。
我们评估了使用含钙透析液和替代液进行的 RCA-CKRT 的安全性和有效性，共纳入 128 例患者。共分析了 571 个滤器和 1227 天的 CKRT。
肝病、无肝病的败血症和合并肝病的败血症。
每 100 天 CKRT 的滤器寿命和代谢并发症。
线性混合效应模型和广义线性混合效应模型。
大多数患者为男性（91 例，71.1%），32 例（25%）有肝病，29 例（22.7%）有非肝病败血症。中位滤器寿命为 50.0（四分位距，22.0-118.0）小时，最长 322 小时，肝病患者明显较低（33.5[四分位距，17.5-60.5]小时）。含钙替代液在所有 CKRT 时间中占 41.6%，使静脉补钙需求减少 31.7%。每 100 天 CKRT 分别有 6.0%和 6.7%的患者出现低钙血症（离子钙<0.85mmol/L）和高钙血症（总钙>10.6mg/dL）。所有患者中有 13.3%观察到枸橼酸盐蓄积，其中 3.9%合并代谢性酸中毒，但在肝病患者中无显著差异（9.3%；P=0.2）。
缺乏使用含钙透析液和 RCA-CKRT 替代液的无钙溶液对照组。由于不完全了解滤器失效的原因，可能高估了滤器寿命。
本研究表明，含钙溶液 RCA-CKRT 在包括败血症和肝病在内的危重症患者中是可行且安全的。
