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Journal of Zhejiang University SCIENCE B 1998 Vol.-1 No.-1 P.

http://doi.org/10.1631/jzus.B2200082


Application of regional citrate anticoagulation in patients at high risk of bleeding during intermittent hemodialysis: a prospective multicenter randomized controlled trial


Author(s):  Xiaoyan TANG, Dezheng CHEN, Ling ZHANG, Ping FU, Yanxia CHEN, Zhou XIAO, Xiangcheng XIAO, Weisheng PENG, Li CHENG, Yanmin ZHANG, Hongbo LI, Kehui LI, Bizhen GOU, Xin WU, Qian YU, Lijun JIAN, Zaizhi ZHU, Yu WEN, Cheng LIU, Hen XUE, Hongyu ZHANG, Xin HE, Bin YAN, LiPing ZHONG, Bin HUANG, MingYing MAO

Affiliation(s):  Division of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China; more

Corresponding email(s):   zhangling_crrt@163.com

Key Words:  regional citrate anticoagulation, intermittent hemodialysis, calcium-containing dialysate, saline flushing, anticoagulation


Xiaoyan TANG, Dezheng CHEN, Ling ZHANG, Ping FU, Yanxia CHEN, Zhou XIAO, Xiangcheng XIAO, Weisheng PENG, Li CHENG, Yanmin ZHANG, Hongbo LI, Kehui LI, Bizhen GOU, Xin WU, Qian YU, Lijun JIAN, Zaizhi ZHU, Yu WEN, Cheng LIU, Hen XUE, Hongyu ZHANG, Xin HE, Bin YAN, LiPing ZHONG, Bin HUANG, MingYing MAO. Application of regional citrate anticoagulation in patients at high risk of bleeding during intermittent hemodialysis: a prospective multicenter randomized controlled trial[J]. Journal of Zhejiang University Science B, 1998, -1(-1): .

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author="Xiaoyan TANG, Dezheng CHEN, Ling ZHANG, Ping FU, Yanxia CHEN, Zhou XIAO, Xiangcheng XIAO, Weisheng PENG, Li CHENG, Yanmin ZHANG, Hongbo LI, Kehui LI, Bizhen GOU, Xin WU, Qian YU, Lijun JIAN, Zaizhi ZHU, Yu WEN, Cheng LIU, Hen XUE, Hongyu ZHANG, Xin HE, Bin YAN, LiPing ZHONG, Bin HUANG, MingYing MAO",
journal="Journal of Zhejiang University Science B",
volume="-1",
number="-1",
pages="",
year="1998",
publisher="Zhejiang University Press & Springer",
doi="10.1631/jzus.B2200082"
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%0 Journal Article
%T Application of regional citrate anticoagulation in patients at high risk of bleeding during intermittent hemodialysis: a prospective multicenter randomized controlled trial
%A Xiaoyan TANG
%A Dezheng CHEN
%A Ling ZHANG
%A Ping FU
%A Yanxia CHEN
%A Zhou XIAO
%A Xiangcheng XIAO
%A Weisheng PENG
%A Li CHENG
%A Yanmin ZHANG
%A Hongbo LI
%A Kehui LI
%A Bizhen GOU
%A Xin WU
%A Qian YU
%A Lijun JIAN
%A Zaizhi ZHU
%A Yu WEN
%A Cheng LIU
%A Hen XUE
%A Hongyu ZHANG
%A Xin HE
%A Bin YAN
%A LiPing ZHONG
%A Bin HUANG
%A MingYing MAO
%J Journal of Zhejiang University SCIENCE B
%V -1
%N -1
%P
%@ 1673-1581
%D 1998
%I Zhejiang University Press & Springer
%DOI 10.1631/jzus.B2200082

TY - JOUR
T1 - Application of regional citrate anticoagulation in patients at high risk of bleeding during intermittent hemodialysis: a prospective multicenter randomized controlled trial
A1 - Xiaoyan TANG
A1 - Dezheng CHEN
A1 - Ling ZHANG
A1 - Ping FU
A1 - Yanxia CHEN
A1 - Zhou XIAO
A1 - Xiangcheng XIAO
A1 - Weisheng PENG
A1 - Li CHENG
A1 - Yanmin ZHANG
A1 - Hongbo LI
A1 - Kehui LI
A1 - Bizhen GOU
A1 - Xin WU
A1 - Qian YU
A1 - Lijun JIAN
A1 - Zaizhi ZHU
A1 - Yu WEN
A1 - Cheng LIU
A1 - Hen XUE
A1 - Hongyu ZHANG
A1 - Xin HE
A1 - Bin YAN
A1 - LiPing ZHONG
A1 - Bin HUANG
A1 - MingYing MAO
J0 - Journal of Zhejiang University Science B
VL - -1
IS - -1
SP -
EP -
%@ 1673-1581
Y1 - 1998
PB - Zhejiang University Press & Springer
ER -
DOI - 10.1631/jzus.B2200082


Abstract: 
Objective: Safe and effective anticoagulation is essential for hemodialysis patients who are at high risk of bleeding. The purpose of this trial is to evaluate the effectiveness and safety of two-stage anticoagulation%29&ck%5B%5D=abstract&ck%5B%5D=keyword'>regional citrate anticoagulation (RCA) combined with sequential anticoagulation and standard calcium-containing dialysate in intermittent hemodialysis (IHD) treatment. Methods: Patients at high risk of bleeding who underwent IHD from September 2019 to May 2021 were prospectively enrolled in 13 blood purification centers of nephrology departments, and were randomly divided into RCA group and saline flushing group. In the RCA group, 4% sodium citrate was infused from the start of the dialysis line during blood draining and at the venous expansion chamber. The sodium citrate was stopped after 3 hours of dialysis and changed to sequential dialysis without anticoagulant. The hazard ratios for coagulation were according to baseline. Results: A total of 159 patients and 208 sessions were enrolled, including RCA group (80 patients, 110 sessions) and saline flushing group (79 patients, 98 sessions). The incidence of severe coagulation events of extracorporeal circulation (ECC) in the RCA group was significantly lower than that in the saline flushing group (3.64% vs. 20.41%, P < 0.001). The survival time of the filter pipeline in the RCA group was significantly longer than that in the saline flushing group (238.34 ± 9.33) minutes vs. (221.73 ± 34.1) minutes, P < 0.001). The Kt/V in the RCA group was similar to that in the saline flushing group, with no statistically significant difference (1.12 ± 0.34 vs. 1.08 ± 0.34, P = 0.41). Conclusion: Compared with saline flushing, the two-stage RCA combined with sequential anticoagulation strategy significantly reduced ECC clotting events and prolonged the dialysis time without serious adverse events.

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