Application of local citrate anticoagulation and heparin-free dialysis in hemodialysis of patients with high risk of bleeding tendency_West China Medical Journal

Authors：

LIU Sinan ¹ ,  CHEN Lin ¹ , CAO Xiaoyi ²

1. Hemodialysis Center of Nephrology Department, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Continuing Education Section, Nursing Department, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

CHEN Lin, Email: hxxuetou@163.com

Keywords：

Hemodialysis; Citrate; Effectiveness; Safety

DOI：

10.7507/1002-0179.201906040

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Objective To evaluate the safety and efficacy of local sodium citrate anticoagulation for routine hemodialysis in high-risk patients with hemorrhage.Methods A total of 150 patients who were admitted to West China Hospital from October 2018 to March 2019 for routine hemodialysis treatment with high-risk bleeding were selected as study objects. The patients were divided into without heparin anticoagulation group (group A) and with 4% sodium citrate anticoagulation group (group B) by random number table method, with 75 cases in each group. Biochemical indicators, serum calcium ion concentration, local anticoagulation safety index of citrate and dialysis adequacy index, blood coagulation in dialyzer and tube during dialysis wre observed in the two groups.Results The coagulation events in group B were significantly lower than those in group A (Z=–4.889, P<0.001), and the urea clearance index in group B was higher than that in group A [(1.26±0.12) vs. (0.73±0.13) L/(min·1.73 m²); t=22.418, P<0.05]. There was a significant difference in the changes of urea nitrogen [(3.53±1.05) vs.(3.12±1.11) mmol/L; t=2.323, P=0.021] 24 hours after dialysis; other indicators showed no statistically significant difference (P>0.05). After the filter, serum calcium ion concentrations in group B at different time points were lower than those in group A [2 hours: (0.52±0.07) vs. (0.64±0.08) mmol/L; 4 hours: (0.56±0.09) vs.(0.63±0.09) mmol/L; t=5.198, 0.525, P<0.001], and the coagulation time was higher in group B than that in group A [2 hours: (172.56±14.78) vs. (151.45±19.81) s; 4 hours: (168.45±16.48) vs. (152.88±16.54) s; t=7.396, 5.775, P<0.001]. None of the patients had dialysis-related adverse events.Conclusion Four percent sodium citrate is effective and safe in anticoagulation therapy for hemodialysis patients, and it can reduce the risk of coagulation in dialyzer and ensure the adequacy of maintenance hemodialysis.

Citation： LIU Sinan, CHEN Lin, CAO Xiaoyi. Application of local citrate anticoagulation and heparin-free dialysis in hemodialysis of patients with high risk of bleeding tendency. West China Medical Journal, 2019, 34(8): 928-932. doi: 10.7507/1002-0179.201906040 Copy

1.	赵筱娟, 李红莉, 安文军. 血液透析过程中局部枸橼酸钠抗凝和普通肝素抗凝的临床随机对照研究. 实用药物与临床, 2018, 21(3): 279-282.
2.	Krishnamurthy S, Yun YS. Recovery of microbially synthesized gold nanoparticles using sodium citrate and detergents. Chem Eng J, 2013, 214: 253-261.
3.	朱淑华, 樊蓉, 徐斌, 等. 简化枸橼酸抗凝无肝素透析的疗效观察. 肾脏病与透析肾移植杂志, 2017, 26(4): 323-327.
4.	李莉, 陆林, 樊蓉. 局部枸橼酸抗凝在无肝素血液透析治疗中的应用及护理. 东南国防医药, 2015, 28(6): 666-668.
5.	王婷立, 张凌, 陈志文, 等. 枸橼酸抗凝在持续缓慢低效血液透析中的应用. 中华内科杂志, 2014, 53(12): 953-956.
6.	王奎, 杨定平. 局部枸橼酸抗凝在高危出血风险血液透析患者中的应用. 临床肾脏病杂志, 2018, 18(1): 17-20.
7.	王文琰, 赵非, 陈秋霞, 等. 枸橼酸局部抗凝在尿毒症儿童维持性血液透析中的应用. 南京医科大学学报(自然科学版), 2018, 38(11): 1615-1618, 1647.
8.	Lifson ML, Levey CG, Gibson UJ. Diameter and location control of ZnO nanowires using electrodeposition and sodium citrate. Appl Phys A Mater Sci Process, 2013, 113(1): 243-247.
9.	吴青, 陈新, 周小华, 等. 不同抗凝方式对急性肾损伤患者持续性肾脏替代治疗的疗效比较. 中国药业, 2018, 27(1): 64-66.
10.	于海鹰, 李松, 毕桂玲. 血液透析中局部枸橼酸与小剂量低分子肝素抗凝的联合应用分析. 中国医药导刊, 2016, 18(6): 618-620.
11.	Mehrizi S, Sohi MH, Saremi M. Effect of sodium citrate as complexing on electrochemical behavior and speciation diagrams of CoFeNiCu baths. Ionics (Kiel), 2013, 19(6): 911-918.
12.	徐志坚, 李桂兰, 林瑛, 等. 低浓度枸橼酸盐局部抗凝技术对改善高危出血倾向行CRRT治疗的疗效分析. 浙江临床医学, 2016, 18(8): 1432-1433, 1440.
13.	Yin Y, Xu BL, Li Z, et al. Enhanced production of (+)-terrein in fed-batch cultivation of aspergillus terreus strain PF26 with sodium citrate. World J Microbiol Biotechnol, 2013, 29(3): 441-446.
14.	Jung MW, Kang SK, Lee JH. Effects of sodium citrate concentration on electroless Ni-Fe Bath stability and deposition. J Electronic Mater, 2014, 43(1): 290-298.
15.	Zafarani-Moattar MT, Jafari P. Phase diagrams for liquid-liquid and liquid-solid equilibrium of the ternary polyethylene glycol+di-sodium hydrogen citrate+water system. Fluid Phase Equilib, 2013, 337(15): 224-233.
16.	唐琦, 张黎明, 邬碧波, 等. 局部枸橼酸体外抗凝、低分子量肝素和无肝素抗凝对高危出血倾向患者行血液透析的疗效和安全性. 上海医学, 2007, 30(12): 898-901.
17.	Kannan R, Ganesan S, Selvakumari TM. An investigation on effects of annealing on magnetic properties of Ni-Fe-W-S electrodeposited coatings in tri Sodium citrate Bath. Iran J Sci Technol, 2013, 37(2): 181-187.
18.	Wang Y, Wang D, Wei G, et al. Improved co-production of S-adenosylmethionine and glutathione using citrate as an auxiliary energy substrate. Bioresour Technol, 2013, 131(12): 28-32.
19.	Lim EK, Seow YT, Chen SE, et al. Simple citrate anticoagulation protocol for low flux haemodialysis. BMC Nephrol, 2018, 19(1): 16.

1. 赵筱娟, 李红莉, 安文军. 血液透析过程中局部枸橼酸钠抗凝和普通肝素抗凝的临床随机对照研究. 实用药物与临床, 2018, 21(3): 279-282.
2. Krishnamurthy S, Yun YS. Recovery of microbially synthesized gold nanoparticles using sodium citrate and detergents. Chem Eng J, 2013, 214: 253-261.
3. 朱淑华, 樊蓉, 徐斌, 等. 简化枸橼酸抗凝无肝素透析的疗效观察. 肾脏病与透析肾移植杂志, 2017, 26(4): 323-327.
4. 李莉, 陆林, 樊蓉. 局部枸橼酸抗凝在无肝素血液透析治疗中的应用及护理. 东南国防医药, 2015, 28(6): 666-668.
5. 王婷立, 张凌, 陈志文, 等. 枸橼酸抗凝在持续缓慢低效血液透析中的应用. 中华内科杂志, 2014, 53(12): 953-956.
6. 王奎, 杨定平. 局部枸橼酸抗凝在高危出血风险血液透析患者中的应用. 临床肾脏病杂志, 2018, 18(1): 17-20.
7. 王文琰, 赵非, 陈秋霞, 等. 枸橼酸局部抗凝在尿毒症儿童维持性血液透析中的应用. 南京医科大学学报(自然科学版), 2018, 38(11): 1615-1618, 1647.
8. Lifson ML, Levey CG, Gibson UJ. Diameter and location control of ZnO nanowires using electrodeposition and sodium citrate. Appl Phys A Mater Sci Process, 2013, 113(1): 243-247.
9. 吴青, 陈新, 周小华, 等. 不同抗凝方式对急性肾损伤患者持续性肾脏替代治疗的疗效比较. 中国药业, 2018, 27(1): 64-66.
10. 于海鹰, 李松, 毕桂玲. 血液透析中局部枸橼酸与小剂量低分子肝素抗凝的联合应用分析. 中国医药导刊, 2016, 18(6): 618-620.
11. Mehrizi S, Sohi MH, Saremi M. Effect of sodium citrate as complexing on electrochemical behavior and speciation diagrams of CoFeNiCu baths. Ionics (Kiel), 2013, 19(6): 911-918.
12. 徐志坚, 李桂兰, 林瑛, 等. 低浓度枸橼酸盐局部抗凝技术对改善高危出血倾向行CRRT治疗的疗效分析. 浙江临床医学, 2016, 18(8): 1432-1433, 1440.
13. Yin Y, Xu BL, Li Z, et al. Enhanced production of (+)-terrein in fed-batch cultivation of aspergillus terreus strain PF26 with sodium citrate. World J Microbiol Biotechnol, 2013, 29(3): 441-446.
14. Jung MW, Kang SK, Lee JH. Effects of sodium citrate concentration on electroless Ni-Fe Bath stability and deposition. J Electronic Mater, 2014, 43(1): 290-298.
15. Zafarani-Moattar MT, Jafari P. Phase diagrams for liquid-liquid and liquid-solid equilibrium of the ternary polyethylene glycol+di-sodium hydrogen citrate+water system. Fluid Phase Equilib, 2013, 337(15): 224-233.
16. 唐琦, 张黎明, 邬碧波, 等. 局部枸橼酸体外抗凝、低分子量肝素和无肝素抗凝对高危出血倾向患者行血液透析的疗效和安全性. 上海医学, 2007, 30(12): 898-901.
17. Kannan R, Ganesan S, Selvakumari TM. An investigation on effects of annealing on magnetic properties of Ni-Fe-W-S electrodeposited coatings in tri Sodium citrate Bath. Iran J Sci Technol, 2013, 37(2): 181-187.
18. Wang Y, Wang D, Wei G, et al. Improved co-production of S-adenosylmethionine and glutathione using citrate as an auxiliary energy substrate. Bioresour Technol, 2013, 131(12): 28-32.
19. Lim EK, Seow YT, Chen SE, et al. Simple citrate anticoagulation protocol for low flux haemodialysis. BMC Nephrol, 2018, 19(1): 16.

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