Department of Cardiology, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.
Department of Emergency, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.
Semin Dial. 2024 May-Jun;37(3):249-258. doi: 10.1111/sdi.13200. Epub 2024 Mar 5.
Calcium-free (Ca-free) solutions are theoretically the most ideal for regional citrate anticoagulation (RCA) in continuous renal replacement therapy (CRRT). However, the majority of medical centers in China had to make a compromise of using commercially available calcium-containing (Ca-containing) solutions instead of Ca-free ones due to their scarcity. This study was designed to probe into the potential of Ca-containing solution as a secure and efficient substitution for Ca-free solutions.
In this prospective, randomized single-center trial, 99 patients scheduled for CRRT were randomly assigned in a 1:1:1 ratio to one of three treatment groups: continuous veno-venous hemodialysis Ca-free dialysate (CVVHD Ca-free) group, continuous veno-venous hemodiafiltration calcium-free dialysate (CVVHDF Ca-free) group, and continuous veno-venous hemodiafiltration Ca-containing dialysate (CVVHDF Ca-containing) group at cardiac intensive care unit (CICU). The primary endpoint was the incidence of metabolic complications. The secondary endpoints included premature termination of treatment, thrombus of filter, and bubble trap after the process.
The incidence of citrate accumulation (18.2% vs. 12.1% vs. 21.2%) and metabolic alkalosis (12.1% vs. 0% vs. 9.1%) did not significantly differ among three groups (p > 0.05 for both). The incidence of premature termination was comparable among the groups (18.2% vs. 9.1% vs. 9.1%, p = 0.582). The thrombus level of the filter and bubble trap was similar in the three groups (p > 0.05 for all).
In RCA-CRRT for CICU population, RCA-CVVHDF with Ca-containing solutions and traditional RCA with Ca-free solutions had a comparable safety and feasibility.
ChiCTR2100048238 in the Chinese Clinical Trial Registry.
在连续肾脏替代治疗（CRRT）中，无钙（Ca-free）溶液在理论上是区域枸橼酸盐抗凝（RCA）最理想的选择。然而，由于其稀缺性，中国大多数医疗中心不得不妥协，使用市售含钙（Ca-containing）溶液代替无钙溶液。本研究旨在探讨含 Ca 溶液作为安全有效替代无 Ca 溶液的潜力。
在这项前瞻性、随机、单中心试验中，99 例计划接受 CRRT 的患者以 1:1:1 的比例随机分配至三组治疗组之一：连续静脉-静脉血液透析无钙透析液（CVVHD Ca-free）组、连续静脉-静脉血液透析滤过无钙透析液（CVVHDF Ca-free）组和连续静脉-静脉血液透析滤过含钙透析液（CVVHDF Ca-containing）组，在心脏重症监护病房（CICU）进行治疗。主要终点是代谢并发症的发生率。次要终点包括治疗提前终止、滤器血栓和气泡捕集器在治疗过程后的情况。
三组患者枸橼酸盐蓄积（18.2% vs. 12.1% vs. 21.2%）和代谢性碱中毒（12.1% vs. 0% vs. 9.1%）的发生率无显著差异（均 p>0.05）。三组患者治疗提前终止的发生率相当（18.2% vs. 9.1% vs. 9.1%，p=0.582）。三组患者滤器和气泡捕集器的血栓水平相似（均 p>0.05）。
在 CICU 人群的 RCA-CRRT 中，含 Ca 的 RCA-CVVHDF 和传统的无 Ca 的 RCA 具有相似的安全性和可行性。
ChiCTR2100048238 于中国临床试验注册中心。
