Lefevre Flora, Vial Romain, Grellier Sophie, Bujon Solène, Bouchouareb Dammar, Brunet Philippe, Scarfoglière Violaine, Robert Thomas
Centre of Nephrology and Renal Transplantation, Hôpital de la Conception, CHU de Marseille, Marseille, France.
Centre of Nephrology and Hemodialysis, Hôpital Sainte Musse, Toulon, France.
Clin Kidney J. 2024 Jul 2;17(8):sfae201. doi: 10.1093/ckj/sfae201. eCollection 2024 Aug.
In chronic intermittent hemodialysis, heparin is the standard anticoagulant as is the use of acid-containing dialysate. Regional anticoagulation (RA) with a calcium-free, citrate-containing dialysate has been developed. We compared RA using a calcium-free, citrate-free dialysate, routinely used in our center, versus systemic heparinization.
In a retrospective, observational, single-center, crossover study, we examined 15 patients undergoing chronic hemodialysis who were at high risk of bleeding and temporarily unable to use heparin. These patients received temporary treatment with RA involving calcium-free and citrate-free dialysate. We compared the dialysis session success rates during two distinct periods: standard heparinization and RA procedure with a calcium-free and citrate-free dialysate.
In our study of 15 patients on chronic hemodialysis which compared 30 RA sessions versus 28 heparin-based anticoagulation session, we observed a 100% success rate with a median session duration of 240 min in both RA and heparin groups. No early extracorporeal circulation (ECC) loss was reported. However, we noted significant differences in the post-dialysis ECC thrombosis scores, with higher Global Thrombosis Index (GTI) and higher membrane coagulation scores in the RA group (< .007 and < .02, respectively). No hypocalcaemia or hypercalcemia symptoms occurred. Median post-filter ionized calcium levels were 0.32 (0.29-0.39) mmol/L at 30 min and median patient ionized calcium levels was 1.19 (1.135-1.28) mmol/L at 60 min. No significant difference in per-dialysis arterial blood pressure was observed between groups.
Our study evaluated the RA approach using a calcium-free, citrate-free acetate dialysate in a chronic hemodialysis center and found it effective. Although an acid-free dialysate was not used in this study, our findings suggest it could be the next frontier in the evolution of advanced dialysis techniques.
在慢性间歇性血液透析中，肝素是标准的抗凝剂，含酸透析液的使用也是如此。已经开发出使用无钙、含柠檬酸盐透析液的局部抗凝（RA）方法。我们比较了使用我们中心常规使用的无钙、无柠檬酸盐透析液的RA与全身肝素化。
在一项回顾性、观察性、单中心交叉研究中，我们检查了15例接受慢性血液透析且有高出血风险且暂时无法使用肝素的患者。这些患者接受了使用无钙、无柠檬酸盐透析液的RA临时治疗。我们比较了两个不同时期的透析 session 成功率：标准肝素化和使用无钙、无柠檬酸盐透析液的RA程序。
在我们对15例慢性血液透析患者的研究中，比较了30次RA session与28次基于肝素的抗凝session，我们观察到RA组和肝素组的成功率均为100%，中位session持续时间为240分钟。未报告早期体外循环（ECC）损失。然而，我们注意到透析后ECC血栓形成评分存在显著差异，RA组的全球血栓形成指数（GTI）更高，膜凝血评分更高（分别<0.007和<0.02）。未出现低钙血症或高钙血症症状。30分钟时滤器后离子钙水平中位数为0.32（0.29 - 0.39）mmol/L，60分钟时患者离子钙水平中位数为1.19（1.135 - 1.28）mmol/L。两组之间透析期间动脉血压无显著差异。
我们的研究评估了在慢性血液透析中心使用无钙、无柠檬酸盐醋酸盐透析液的RA方法，并发现其有效。尽管本研究未使用无酸透析液，但我们的发现表明它可能是先进透析技术发展的下一个前沿领域。
