Sheng Ruanmei, Liu Yimeng, Li Shaolin, Chen Jianqin, Xue Fangying, Dai Zhenjuan, Wang Ruiping, Wang Xuemin
Department of Emergency and Critical Disease, Songjiang Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Technical Center - software Department, SWS Hemodialysis Care Co., Ltd, Chongqing, China.
Clin Kidney J. 2025 Jul 12;18(8):sfaf230. doi: 10.1093/ckj/sfaf230. eCollection 2025 Aug.
Although several regional citrate anticoagulation (RCA) algorithms have been reported, clinical data confirming their effectiveness and safety are limited. We have developed a novel RCA algorithm applicable to extensive continuous renal replacement therapy (CRRT) settings. The aims of this study were to evaluate the incidence of calcium and citrate abnormalities that necessitated human intervention when using this algorithm during RCA and to identify the optimal values of the coefficients and in the equations.
We conducted a prospective, single-arm study in patients who underwent RCA using various CRRT modes and parameters, calcium-containing replacement fluids, and presession blood calcium abnormalities. The primary outcome was the incidence of citrate and calcium overdose and deficiency in the absence of human intervention. Secondary outcomes included the values of and and the occurrence of elevated or decreased blood calcium concentrations during RCA.
A total of 282 RCA sessions in 110 patients were investigated. The incidence of citrate and calcium abnormalities was 19.5% (55/282). In the low-dose citrate sessions, citrate overdose occurred in one session (1/148), while the incidence of citrate deficiency was 22.3% (33/148). In the high-dose citrate sessions, citrate deficiency occurred in two sessions (2/134) and citrate overdose occurred in 18/134 (13.4%) sessions. One session (1/282) of calcium overdose was also observed, whereas no calcium deficiency occurred during RCA.
The application of this innovative RCA algorithm to sessions involving various CRRT conditions markedly decreased the incidence of citrate and calcium abnormalities. As a consequence, this reduction minimized the necessity for modifications to the rate of calcium and citrate supplementation during RCA.
尽管已有多种局部枸橼酸抗凝（RCA）算法被报道，但证实其有效性和安全性的临床数据有限。我们开发了一种适用于广泛连续性肾脏替代治疗（CRRT）场景的新型RCA算法。本研究的目的是评估在RCA期间使用该算法时需要人为干预的钙和枸橼酸异常的发生率，并确定方程中系数和的最佳值。
我们对接受RCA的患者进行了一项前瞻性单臂研究，这些患者使用了各种CRRT模式和参数、含钙置换液以及治疗前血钙异常。主要结局是在无人为干预情况下枸橼酸和钙过量及缺乏的发生率。次要结局包括系数和的值以及RCA期间血钙浓度升高或降低的发生情况。
共调查了110例患者的282次RCA治疗。枸橼酸和钙异常的发生率为19.5%（55/282）。在低剂量枸橼酸治疗中，1次治疗（1/148）出现枸橼酸过量，而枸橼酸缺乏的发生率为22.3%（33/148）。在高剂量枸橼酸治疗中，2次治疗（2/134）出现枸橼酸缺乏，18/134（13.4%）次治疗出现枸橼酸过量。还观察到1次治疗（1/282）出现钙过量，而RCA期间未发生钙缺乏。
将这种创新的RCA算法应用于涉及各种CRRT条件的治疗中，显著降低了枸橼酸和钙异常的发生率。因此，这种降低最大限度地减少了RCA期间调整钙和枸橼酸补充速率的必要性。
