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On-line Access: 2022-11-15

Received: 2022-02-17

Revision Accepted: 2022-06-19

Crosschecked: 2022-11-16

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Citations:  Bibtex RefMan EndNote GB/T7714

 ORCID:

Ling ZHANG

https://orcid.org/0000-0003-1155-4802

Xiaoyan TANG

https://orcid.org/0000-0002-3232-593X

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Journal of Zhejiang University SCIENCE B 2022 Vol.23 No.11 P.931-942

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 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, 2022, 23(11): 931-942.

@article{title="Application of regional citrate anticoagulation in patients at high risk of bleeding during intermittent hemodialysis: a prospective multicenter randomized controlled trial",
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="23",
number="11",
pages="931-942",
year="2022",
publisher="Zhejiang University Press & Springer",
doi="10.1631/jzus.B2200082"
}

%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 23
%N 11
%P 931-942
%@ 1673-1581
%D 2022
%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 - 23
IS - 11
SP - 931
EP - 942
%@ 1673-1581
Y1 - 2022
PB - Zhejiang University Press & Springer
ER -
DOI - 10.1631/jzus.B2200082


Abstract: 
ObjectiveSafe 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.
MethodsPatients 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, 0.04 g/mL 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 h of dialysis, which was changed to sequential dialysis without anticoagulant. The hazard ratios for coagulation were according to baseline.
ResultsA 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 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) min vs. (221.73±34.10) min, P<0.001). The urea clearance index (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).
ConclusionsCompared with saline flushing, the two-stage RCA combined with a sequential anticoagulation strategy significantly reduced extracorporeal circulation clotting events and prolonged the dialysis time without serious adverse events.

局部枸橼酸钠抗凝在出血高危患者间歇性血液透析中的临床应用--一项前瞻性多中心随机对照研究

唐小琰1,2,陈德政2,张凌1,付平1,陈艳霞3,肖舟4,肖湘成4,彭卫生4,程力5,张燕敏5,李红波5,李科慧6,芶碧珍7,吴欣7,于黔7,蹇丽君8,朱再志9,温玉10,刘城10,薛痕11,张红玉11,贺欣12,严斌13,钟利平4,黄彬4,毛明英2
1四川大学华西医院肾脏研究所,中国成都市,610041
2四川省简阳市人民医院肾内科,中国成都市,641400
3南昌大学第二附属医院肾内科,中国南昌市,330006
4中南大学湘雅医院肾内科,中国长沙市,410008
5武汉市第一医院肾内科,中国武汉市,430022
6广西医科大学第一附属医院血液净化部,中国南宁市,530021
7贵阳市第一人民医院肾内科,中国贵阳市,550002
8四川大学华西医院金堂医院肾内科,中国金堂县,610400
9眉山市人民医院肾内科,中国眉山市,620020
10资阳市人民医院肾内科,中国资阳市,641300
11雅安市人民医院肾内科,中国雅安市,625000
12成都康福肾脏病医院肾内科,中国成都市,610047
13凉山彝族自治州第一人民医院肾内科,中国西昌市,615000
目的:安全有效的抗凝治疗对于高危出血风险的血液透析患者至关重要。本试验的目的是评估应用标准含钙透析液进行双段法局部枸橼酸(RCA)联合序贯抗凝在间歇性血液透析(IHD)治疗中的有效性和安全性。
方法:前瞻性纳入13个肾内科血液净化中心2019年9月至2021年5月行IHD的出血高危患者,随机分为RCA组和生理盐水冲洗组。RCA组使用0.04 g/mL枸橼酸钠分别从透析管路的引血端及静脉壶双段输注,透析3小时后停用枸橼酸钠,并改为无抗凝剂模式序贯透析。根据基线计算凝血风险比。
结果:共纳入159名患者208例次,包括RCA组(80名,110例次)和盐水冲洗组(79名,98例次)。RCA组体外循环管路严重凝血事件的发生率明显低于生理盐水冲洗组(3.64% vs. 20.41%,P<0.001)。RCA组滤器管路的生存时间较生理盐水冲洗组明显延长((238.34±9.33) min和(221.73±34.10) min,P<0.001)。RCA组的尿素清除指数(Kt/V)与生理盐水冲洗组相当,差异无统计学意义(1.12±0.34 vs. 1.08±0.34,P=0.41)。
结论:与生理盐水冲洗相比较,双段法枸橼酸联合序贯抗凝能显著减少体外循环凝血事件,延长透析时间,且未观察到严重不良事件发生。

关键词:局部枸橼酸抗凝;间歇性血液透析;含钙透析液;生理盐水冲洗;抗凝

Darkslateblue:Affiliate; Royal Blue:Author; Turquoise:Article

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