Zhang Li, Liu Run
Department of Nephrology, The Second Affiliated Hospital of Hainan Medical University No. 368 Yehai Avenue, Longhua District, Haikou 570100, Hainan, China.
Intensive Care Medicine, The Second Affiliated Hospital of Hainan Medical University No. 368 Yehai Avenue, Longhua District, Haikou 570100, Hainan, China.
Am J Transl Res. 2025 Feb 15;17(2):1302-1310. doi: 10.62347/MVGE5925. eCollection 2025.
OBJECTIVE: To investigate the effect of regional citrate anticoagulation (RCA) on clinical outcome, renal function, and bleeding complications in patients with acute kidney injury (AKI) undergoing continuous renal replacement therapy (CRRT). METHODS: This retrospective study reviewed medical records of 180 patients treated at the Second Affiliated Hospital of Hainan Medical University from January 2020 to January 2023. Patients were divided into two groups based on anticoagulation strategy: 85 patients who received systemic heparin anticoagulation (control group, CG) and 95 patients who received RCA (research group, RG). The clinical efficacy, adverse reactions, and incidence of bleeding complications were compared between the groups. Changes in renal function [blood urea nitrogen (BUN) and serum creatinine (Scr)] and coagulation values [prothrombin time (PT), activated partial thromboplastin time (APTT), and platelet count (PLT)] before and after treatment were also analyzed. RESULTS: The total effective rate was significantly higher in the RG compared to the CG (P<0.05). The incidence of adverse reactions was 12.94% in the CG and 8.42% in the RG, with no statistically significant difference (P>0.05). However, the incidence of bleeding complications was significantly lower in the RG (P<0.05). After treatment, both groups showed significant reductions in BUN and Scr, with the RG exhibiting lower levels than the CG (both P<0.05). In both groups, PT and APTT increased while PLT decreased, but these values were more favorable in the RG (all P<0.05). Logistic regression analysis identified age, AKI stage, and treatment method as independent risk factors influencing treatment efficacy (all P<0.05). Additionally, post-treatment levels of hypersensitive C-reactive protein (hs-CRP) and interleukin-4 (IL-4) decreased in both groups, with the RG showing significantly lower levels than the CG (all P<0.05). CONCLUSION: RCA is effective for AKI patients undergoing CRRT, improving renal and coagulation function, reducing the risk of adverse reactions and bleeding, and demonstrating a favorable safety profile.
目的：探讨局部枸橼酸抗凝（RCA）对接受连续性肾脏替代治疗（CRRT）的急性肾损伤（AKI）患者临床结局、肾功能及出血并发症的影响。 方法：本回顾性研究回顾了2020年1月至2023年1月在海南医学院第二附属医院接受治疗的180例患者的病历。根据抗凝策略将患者分为两组：85例接受全身肝素抗凝的患者（对照组，CG）和95例接受RCA的患者（研究组，RG）。比较两组的临床疗效、不良反应及出血并发症发生率。还分析了治疗前后肾功能[血尿素氮（BUN）和血清肌酐（Scr）]及凝血指标[凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）和血小板计数（PLT）]的变化。 结果：与CG组相比，RG组的总有效率显著更高（P<0.05）。CG组不良反应发生率为12.94%，RG组为8.42%，差异无统计学意义（P>0.05）。然而，RG组出血并发症发生率显著更低（P<0.05）。治疗后，两组BUN和Scr均显著降低，且RG组低于CG组（均P<0.05）。两组PT和APTT均升高而PLT降低，但RG组这些指标更有利（均P<0.05）。Logistic回归分析确定年龄、AKI分期和治疗方法是影响治疗疗效的独立危险因素（均P<0.05）。此外，两组治疗后超敏C反应蛋白（hs-CRP）和白细胞介素-4（IL-4）水平均降低，且RG组显著低于CG组（均P<0.05）。 结论：RCA对接受CRRT的AKI患者有效，可改善肾脏和凝血功能，降低不良反应和出血风险，且安全性良好。
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