Division of Nephrology & Critical Care Nephrology Unit, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Shanghai, China.
Artif Organs. 2022 Jun;46(6):1122-1131. doi: 10.1111/aor.14164. Epub 2022 Jan 11.
Regional citrate anticoagulation has been recommended as an alternative of anticoagulation for patients at high risk of bleeding undergoing intermittent hemodialysis. Precise calcium supplementation is important for the safety of regional citrate anticoagulation. In this study, we aimed to develop a possible method to optimize calcium supplementation for regional citrate anticoagulation in intermittent hemodialysis.
The investigation consisted of a pilot study and a validation study. 18 patients undergoing intermittent hemodialysis anticoagulated by citrate, and six types of filters were included in the pilot study. The ionized calcium levels were monitored and maintained in the targeted range. Calcium-free dialysate was used in the study. After linear regression analysis of the clearance of non-protein bound calcium and calculating the ratio of the non-protein bound calcium concentration to total calcium concentration, we developed a mathematical model for estimation of extracorporeal circuit calcium removal. Another 8 maintenance hemodialysis patients (12 sessions) were enrolled in the validation study to validate the new version of the calcium supplementation approach.
In the pilot study, positive correlations were found between the clearance of non-protein bound calcium and the hematocrit-adjusted clearance of creatinine and phosphate given in the dialyzer leaflet (R = 0.31, p = 0.0165). The ratio of the non-protein bound calcium concentration to total calcium concentration at the pre-filter point after infusion of citrate were constant about 0.75. In the validation study, we found that the systemic ionized calcium levels were stably maintained in the safe range and no filter clotting occurred during the hemodialysis when we used the new model of calcium supplementation.
We developed a possible method to quantify calcium supplementation for intermittent hemodialysis anticoagulated by citrate which may help to avoid negative calcium balance and reduce the incidence of complications.
局部枸橼酸抗凝已被推荐用于出血风险高的间歇性血液透析患者的抗凝替代方法。精确的钙补充对于局部枸橼酸抗凝的安全性非常重要。在这项研究中，我们旨在开发一种可能的方法来优化间歇性血液透析中局部枸橼酸抗凝的钙补充。
该研究包括一项试点研究和一项验证研究。18 名接受枸橼酸抗凝的间歇性血液透析患者，以及 6 种类型的过滤器纳入了试点研究。监测和维持离子钙水平在目标范围内。研究中使用无钙透析液。在对非蛋白结合钙的清除率进行线性回归分析，并计算非蛋白结合钙浓度与总钙浓度的比值后，我们开发了一种用于估计体外回路钙去除的数学模型。另外 8 名维持性血液透析患者（12 次）纳入验证研究，以验证新的钙补充方法。
在试点研究中，发现非蛋白结合钙的清除率与透析器叶片中列出的红细胞压积校正的肌酐和磷酸盐的清除率呈正相关（R=0.31，p=0.0165）。枸橼酸盐输注后预滤器点处非蛋白结合钙浓度与总钙浓度的比值约为 0.75，保持恒定。在验证研究中，我们发现当使用新的钙补充模型时，系统离子钙水平稳定维持在安全范围内，并且在血液透析期间没有过滤器凝血。
我们开发了一种可能的方法来量化间歇性血液透析中枸橼酸抗凝的钙补充，这可能有助于避免负钙平衡和减少并发症的发生。
