Liu Tong, Jiao Jing, Tang Siwei, Tang Siyan, She Lecheng, Tian Xiujuan, Feng Shidong, Chen Xiaolan, Lu Rui, Yu Yan, Qi Xiaoling, Li Yajuan, Sun Shiren, Bai Ming
The Department of Nephrology, Xijing Hospital, The Fourth Military Medical University, No. 127 Changle West Road, Xi'an, 710032, Shaanxi, China.
Yan'an University, No. 580, Shengdi Road, Yan'an, 716000, Shaanxi, China.
Int Urol Nephrol. 2025 Apr;57(4):1319-1327. doi: 10.1007/s11255-024-04305-0. Epub 2024 Dec 9.
Therapeutic plasma exchange (TPE) is an important blood purification technology and most patients require multiple consecutive TPEs. Regional citrate anticoagulation (RCA) could be used for membrane therapeutic plasma exchange (mTPE). However, there is no research on the metabolic complications of the RCA for patients receiving multiple consecutive mTPEs with fresh frozen plasma (FFP) as a replacement solution.
We retrospectively included patients who used RCA for multiple consecutive mTPEs with FFP as a replacement solution in Xijing Hospital from 2020 to 2022. We collected blood gas analysis and electrolyte results before and after mTPE treatment and analysed the anticoagulation effectiveness and metabolic complications of the RCA.
A total of 33 patients who underwent 131 mTPE sessions were included, and 129 (98.5%) sessions were successfully completed. Severe hypocalcemia (19.1%) and metabolic alkalosis (58.5%) were frequently observed. In single mTPE sessions, there was a significant decrease in ionized calcium levels and significant increases in serum sodium, potassium, pH, bicarbonate, and base excess (BE) levels compared to pretreatment values. When comparing the values after the last treatment to the baseline values in all 33 patients, the serum sodium, pH, bicarbonate, and BE levels increased significantly, while the ionized calcium decreased significantly. The levels of pH, bicarbonate, and BE increased with the number of mTPE sessions, and the cumulative incidence of metabolic alkalosis reached 95.2% after the fifth treatment according to the Kaplan-Meier survival analysis.
RCA is an effective anticoagulation method for patients undergoing mTPE with FFP as a replacement solution. However, the metabolic complications associated with RCA, especially hypocalcemia and metabolic alkalosis, frequently develop in patients who undergo multiple consecutive mTPEs with FFP.
治疗性血浆置换（TPE）是一项重要的血液净化技术，大多数患者需要连续多次进行TPE。局部枸橼酸盐抗凝（RCA）可用于膜式治疗性血浆置换（mTPE）。然而，对于以新鲜冰冻血浆（FFP）作为置换液连续多次接受mTPE治疗的患者，关于RCA代谢并发症的研究尚无报道。
我们回顾性纳入了2020年至2022年在西京医院以FFP作为置换液连续多次接受mTPE治疗并使用RCA的患者。我们收集了mTPE治疗前后的血气分析和电解质结果，并分析了RCA的抗凝效果和代谢并发症。
共纳入33例接受131次mTPE治疗的患者，其中129次（98.5%）治疗成功完成。频繁观察到严重低钙血症（19.1%）和代谢性碱中毒（58.5%）。在单次mTPE治疗中，与治疗前值相比，离子钙水平显著降低，血清钠、钾、pH值、碳酸氢盐和碱剩余（BE）水平显著升高。将所有33例患者最后一次治疗后的数值与基线值进行比较时，血清钠、pH值、碳酸氢盐和BE水平显著升高，而离子钙显著降低。pH值、碳酸氢盐和BE水平随mTPE治疗次数增加而升高，根据Kaplan-Meier生存分析，第五次治疗后代谢性碱中毒的累积发生率达到95.2%。
RCA是一种用于以FFP作为置换液进行mTPE治疗患者的有效抗凝方法。然而，与RCA相关的代谢并发症，尤其是低钙血症和代谢性碱中毒，在以FFP连续多次接受mTPE治疗的患者中经常发生。
