Division of Nephrology and Critical Care Nephrology Unit, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Shanghai, China (mainland).
Med Sci Monit. 2021 Apr 16;27:e930513. doi: 10.12659/MSM.930513.
BACKGROUND Regional citrate anticoagulation (RCA) is a recommended anticoagulation alternative for patients at high risk of bleeding while undergoing intermittent hemodialysis. Previous reports implied the risk of citrate application on bone metabolism. It is unclear whether long-term use of RCA is safe for maintenance hemodialysis patients in terms of bone metabolism. MATERIAL AND METHODS Seven patients with cerebral hemorrhage were included in the study. Blood samples were collected at baseline and 4 and 8 weeks after treatment. Spent dialysate samples were collected during each mid-week dialysis session, using the partial dialysate collection method. All patients were treated with RCA for 4 to 8 weeks, according to their clinical condition. We assessed bone metabolism-associated parameters, bone turnover markers, and magnesium loss at each dialysis session. RESULTS Serum magnesium levels were 1.24±0.13 mmol/L at baseline and significantly decreased to 1.16±0.14 mmol/L after 4 weeks of RCA treatment (P=0.025). Most patients had negative magnesium balance during citrate hemodialysis. Serum total calcium levels did not change significantly after treatment. One bone marker, N-terminal propeptide of type I procollagen (PINP), significantly decreased from 146.07±130.12 mmol/L to 92.42±79.01 mmol/L after citrate treatment (P=0.018). No significant changes were detected in other bone turnover markers. CONCLUSIONS Relatively long-term RCA treatment may decrease serum magnesium levels due to negative magnesium balance. Bone formation marker PINP seemed to decrease after treatment, while other bone turnover markers did not change significantly. Further investigation is needed to verify the effect of RCA on bone remodeling.
区域枸橼酸抗凝（RCA）是一种推荐的抗凝替代方案，适用于有出血高风险的间歇性血液透析患者。先前的报告表明枸橼酸盐应用于骨代谢存在风险。尚不清楚长期使用 RCA 对维持性血液透析患者的骨代谢是否安全。
本研究纳入了 7 例脑出血患者。在基线、治疗后 4 周和 8 周采集血样。使用部分透析液采集方法，在每个透析日的中期透析期间采集废弃透析液样本。所有患者根据临床情况接受 RCA 治疗 4 至 8 周。我们在每次透析时评估骨代谢相关参数、骨转换标志物和镁丢失情况。
基线时血清镁水平为 1.24±0.13mmol/L，RCA 治疗 4 周后显著下降至 1.16±0.14mmol/L（P=0.025）。大多数患者在枸橼酸盐血液透析期间存在镁负平衡。治疗后血清总钙水平无明显变化。一种骨标志物，I 型前胶原 N 端前肽（PINP），从治疗前的 146.07±130.12mmol/L 显著下降至治疗后的 92.42±79.01mmol/L（P=0.018）。其他骨转换标志物无明显变化。
相对长期的 RCA 治疗可能会由于镁负平衡而导致血清镁水平降低。治疗后骨形成标志物 PINP 似乎下降，而其他骨转换标志物无明显变化。需要进一步研究以验证 RCA 对骨重塑的影响。
