Application of simplified regional citrate anticoagulation in hemodialysis patients with high risk of bleeding

2022 ◽  
Author(s):  
Wei Wang ◽  
Shaoyan Zhang ◽  
Yuehong Li ◽  
Xianglan Wu ◽  
Hua Yang ◽  
...  
Keyword(s):  
High Risk ◽  
Hemodialysis Patients ◽  
Regional Citrate Anticoagulation ◽  
Citrate Anticoagulation ◽  
Risk Of Bleeding

scholarly journals Modified regional citrate anticoagulation is optimal for hemodialysis in patients at high risk of bleeding: a prospective randomized study of three anticoagulation strategies

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Ting Lin ◽  
Li Song ◽  
Renwei Huang ◽  
Ying Huang ◽  
Shuifu Tang ◽  
...  
Keyword(s):  
High Risk ◽  
Randomized Study ◽  
Bleeding Risk ◽  
Saline Group ◽  
Regional Citrate Anticoagulation ◽  
Expansion Chamber ◽  
Citrate Anticoagulation ◽  
Risk Of Bleeding ◽  
Group 4 ◽  
High Bleeding Risk

Abstract Background Recommended regular saline flushing presents clinical ineffectiveness for hemodialysis (HD) patients at high risk of bleeding with heparin contraindication. Regional citrate anticoagulation (RCA) has previously been used with a Ca2+ containing dialysate with prefiltered citrate in one arm (RCA-one). However, anticoagulation is not always achievable and up to 40% results in serious clotting in the venous expansion chamber. In this study, we have transferred one-quarter of the TSC from the prefiltered to the post filter based on RCA-one, which we have called RCA-two. The objective of this study was to compare the efficacy and safety of RCA-two with either saline flushing or RCA-one in HD patients with a high bleeding risk. Method In this investigator-initiated, multicenter, controlled, prospective, randomized clinical trial, 52 HD patients (77 sessions) were randomized to the RCA-2 and RCA-one group in part one of the trial, and 45 patients (64 sessions) were randomized to the RCA-2 and saline group in part two of the trial. Serious clotting events, adverse events and blood analyses were recorded. Results Serious clotting events in the RCA-two group were significantly lower compared with the RCA-one and saline group (7.89% vs. 30.77%, P = 0.011; 3.03% vs. 54.84%, P < 0.001, respectively). The median circuit survival time was 240 min (IQR 240 to 240) in the RCA-two group, was significantly longer than 230 min (IQR 155 to 240, P < 0.001) in the RCA-one group and 210 min (IQR 135 to 240, P = 0.003) in the saline group. The majority of the AEs were hypotension, hypoglycemia and chest tightness, most of which were mild in intensity. Eight patients (20.51%) in the RCA-one group, 4 patients (12.90%) in the saline group and 10 patients (26.31%) in the RCA-two group, P > 0.05. Conclusions Our data demonstrated that the modified anticoagulation protocol was more effective and feasible during hemodialysis therapy for patients at high risk of bleeding. Trial registration GDREC, GDREC2017250H. Registered February 2, 2018; retrospectively registered.

scholarly journals Regional citrate-calcium anticoagulation during polymyxin-B hemoperfusion: A case series

2018 ◽  
Vol 41 (6) ◽  
pp. 319-324
Author(s):  
Francesco Forfori ◽  
Etrusca Brogi ◽  
Anna Sidoti ◽  
Martina Giraudini ◽  
Gianpaola Monti ◽  
...  
Keyword(s):  
High Risk ◽  
Surgical Complications ◽  
Case Series ◽  
Polymyxin B ◽  
Regional Citrate Anticoagulation ◽  
Metabolic Complications ◽  
Citrate Anticoagulation ◽  
Risk Of Bleeding ◽  
Published Report ◽  
Polymyxin B Hemoperfusion

Introduction: So far, only heparin-based anticoagulation has been proposed during polymyxin-B hemoperfusion. However, postsurgical septic patients can be at high risk of bleeding due to either surgical complications or septic coagulation derangement. Consequently, heparin should not represent in some cases the anticoagulation regimen of choice in this type of patients. Methods and results: We present a case series of four postsurgical septic patients treated with polymyxin-B hemoperfusion using regional citrate anticoagulation. All the treatments were performed without complications. During each treatment, there were no episodes of filter clotting, no bleeding, and no metabolic complications for any of the patients. Conclusion: To our knowledge, this is the second published report on the use of citrate anticoagulation during polymyxin-B hemoperfusion. Our case series continued to show that regional citrate anticoagulation regimen is feasible and safe during polymyxin-B hemoperfusion treatment in postsurgical septic patients.

scholarly journals Modified regional citrate anticoagulation is optimal for hemodialysis in patients at high risk of bleeding: A prospective randomized study of three anticoagulation strategies

2019 ◽  
Author(s):  
Ting Lin ◽  
Li Song ◽  
Renwei Huang ◽  
Ying Huang ◽  
Shuifu Tang ◽  
...  
Keyword(s):  
High Risk ◽  
Randomized Study ◽  
Bleeding Risk ◽  
Saline Group ◽  
Regional Citrate Anticoagulation ◽  
Expansion Chamber ◽  
Citrate Anticoagulation ◽  
Risk Of Bleeding ◽  
Group 4 ◽  
High Bleeding Risk

Abstract ABSTRACT Background： Recommended regular saline flushing presents clinical ineffectiveness for hemodialysis (HD) patients at high risk of bleeding with heparin contraindication. Regional citrate anticoagulation (RCA) has previously been used with a Ca 2+ containing dialysate with prefiltered citrate in one arm (RCA-one). However, anticoagulation is not always achievable and up to 40% results in serious clotting in the venous expansion chamber. In this study, we have transferred one-quarter of the TSC from the prefiltered to the post filter based on RCA-one, which we have called RCA-two. The objective of this study was to compare the efficacy and safety of RCA-two with either saline flushing or RCA-one in HD patients with a high bleeding risk. Method ： In this investigator-initiated, multicenter, controlled, prospective, randomized clinical trial, 52 HD patients (77 sessions) were randomized to the RCA-two and RCA-one group in part one of the trial, and 45 patients (64 sessions) were randomized to the RCA-two and saline group in part two of the trial. Serious clotting events, adverse events and blood analyses were recorded. Results ：Serious clotting events in the RCA-two group were significantly lower compared with the RCA-one and saline group (7.89% vs. 30.77%, P = 0.011; 3.03% vs. 54.84%, P < 0.001, respectively). The median circuit survival time was 240 min (IQR 240 to 240) in the RCA-two group, was significantly longer than 230 min (IQR 155 to 240, P < 0.001) in the RCA-one group and 210 min (IQR 135 to 240，P = 0.003) in the saline group. The majority of the AEs were hypotension, hypoglycemia and chest tightness, most of which were mild in intensity. Eight patients (20.51%) in the RCA-one group, 4 patients (12.90%) in the saline group and 10 patients (26.31%) in the RCA-two group, P>0.05. Conclusions ： Our data demonstrated that the modified anticoagulation protocol was more effective and feasible during hemodialysis therapy for patients at high risk of bleeding. Trial registration: GDREC, GDREC2017250H. Registered February 2, 2018; prospectively registered.

scholarly journals Treatment Effect of Regional Sodium Citrate Anticoagulation in Elderly Patients With High-Risk Bleeding Receiving Continuous Renal Replacement Therapy

2021 ◽  
Vol 27 ◽  
pp. 107602962110506
Author(s):  
Kang Xun ◽  
Hong Qiu ◽  
Miao Jia ◽  
Lihua Lin ◽  
Meiling He ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
High Risk ◽  
Elderly Patients ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Safety Evaluation ◽  
Regional Citrate Anticoagulation ◽  
Bleeding Events ◽  
Citrate Anticoagulation ◽  
Risk Of Bleeding

Objective To investigate the safety and efficacy of regional citrate anticoagulation (RCA) on elderly patients at high risk of bleeding after continuous renal replacement therapy (CRRT). Methods A total of 31 patients at high risk of bleeding who received CRRT in the intensive care unit were collected. The patients were divided into RCA group (n = 17) and no anticoagulation group (NA, n = 14) according to whether RCA was used or not. The levels of creatinine (Cr), blood urea nitrogen (BUN), prothrombin time (PT), activated partial thromboplastin time (APTT), total calcium (tCa), ionized calcium ion (iCa2+), sodium ion (Na+), bicarbonate ion (HCO3−), tCa/iCa2+ ratio, and pH were observed after treatment. The filter use time, number of filters used, filter obstruction events, clinical outcomes, and safety evaluation indexes were compared post-treatment. Results After treatment, serum Cr and BUN levels, APTT and PT levels in the RCA group were significantly lower than the NA group. The tCa, iCa2+, HCO3−, tCa/iCa2+, and pH were within the normal range after RCA treatment while Na+ levels saw a significant increase. In the RCA group, the filter using time was significantly longer, with significantly reduced numbers of filter use within 72 h and filter disorder events. Additionally, patients in the RCA group showed significant recovery of renal function and a significant reduction in bleeding events and in-hospital mortality. Conclusion RCA treatment significantly improves clinical outcome of patients at high risk of bleeding after CRRT, safely and effectively prolongs the filter life and avoids coagulation incidences.

MO418CONTINUOUS RENAL REPLACEMENT THERAPY WITH REGIONAL CITRATE ANTICOAGULATION VERSUS NON-ANTICOAGULATION REGIME IN CRITICALLY ILL PATIENTS WITH ACUTE KIDNEY INJURY AND A HIGH RISK OF BLEEDING

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Violeta Knezevic ◽  
Tijana Azasevac ◽  
Gordana Strazmester Majstorovic ◽  
Mira Markovic ◽  
Igor Mitic
Keyword(s):  
Acute Kidney Injury ◽  
High Risk ◽  
Kidney Injury ◽  
Regional Citrate Anticoagulation ◽  
Mean Values ◽  
Citrate Anticoagulation ◽  
Risk Of Bleeding ◽  
Saps Ii ◽  
Saps Ii Score ◽  
Significant Difference

Abstract Background and Aims Critically ill patients with acute renal impairment (AKI) with a high risk of bleeding require treatment with one of the methods of continuous renal replacement (CRRT) with regional citrate anticoagulation (RCA) or without anticoagulation (NA). The aim of the study was to compare CRRT with RCA using calcium with CRRT in NA regimen. Method A clinical trial included 55 surgical and non-surgical patients with acute kidney injury and an episode of acute kidney injury in chronic kidney disease who were admitted to the Intensive Care Unit (ICU) during 2020. The patients were divided into two groups, RCA- CRRT with 39 and NA-CRRT with 16 patients. Demographic, clinical and lab data before and after CRRT, treatment parameters CRRT and outcomes were analyzed. Results RCA vs NA group did not differ significantly by gender (small, 71.79% vs 56.25%, p = 0.106) and age (56.53 ± 17.55 vs 45.75 ± 13.3, p = 0.220). The NA group had a significantly higher prevalence of liver disease as a reason for the ICU admission when compared to the other group (12.5% vs 0.00%, p = 0.024). The RCA group before CRRT had significantly higher mean values of CRP (173.68 ± 122.06 vs 86.33 ± 51.05, p = 0.01) and significantly lower mean values of total bilirubin (16.78 ± 4.31 vs 40.02 ± 9.22, p = 0.005) and creatinine (463.97 ± 36.24 vs 486.0 ± 36.25, p = 0.001), while after CRRT it had significantly higher average values of total calcium (2.12 ± 0.016 vs 2.11 ± 0.017, p = 0.023) and lower average values of pH (7.29 ± 0.02 vs 7.32 ± 0.015, p = 0.040) and creatinine (463.97 ± 36.24 vs 486.0 ± 36.25, p = 0.001) in relation to the NA group. No significant difference was found in relation to invasive mechanical ventilation, vasopressors therapy, SAPS II score, oliguria / anuria, recovery of renal function, the length of hospital stay and mortality (p&gt; 0.05) (Table 1). Compared to treatment parameters, the RCA group had a significantly lower number of procedures (4.33 ± 2.80 vs 5.81 ± 1.28, p = 0.027) and ultrafiltration rate (2.79 ± 0.19 vs 3.14 ± 0.33, p = 0.015) and significantly longer hemofilter lifespan compared to NA group (24.64 ± 0.48 vs 18.10 ± 0.58, p = 0.000). Although the prevalence of bleeding was higher in the NA group, no significant difference was found between the groups (37.5% vs 28.20%, p = 0.498), as well as in the infusion of red blood cell (33.3% vs 37.5%, p = 0.768), fresh frozen plasma (28.2% vs 50%, p = 0.742) and platelets (35.89 vs 31.25, p = 0.123). The overall citrate accumulation (CA&gt; 2.25) rate was 5.12% in the RCA group (Table 2). The Kaplan-Meier survival analysis using the log-rank test (Mantel-Cox test) for comparing the hemofilter lifespan between RCA and NA regime found a significant difference in survival between the groups (χ2 = 3,789, p = 0,049) (Figure 1). Multiple regression model for testing risk factors SAPS II score, Oxiris membrane, UF, lactate, hemoglobin concentration, platelet count, Activated Partial Thromboplastin Time and Prothrombin Time on hemofilter survival has shown a significant linear relationship without statistical significance in both RCA groups (R=0.544 ; F=1.575) and NA (R=0.757; F=1.171) (Table 3). Conclusion RCA-CRRT did not show a significant difference in the prevalence of bleeding compared to NA-CRRT in the patients with a high risk of bleeding, but the survival rate of hemofilters was significantly longer in RCA-CRRT, which suggested the need for further research.

scholarly journals Modified regional citrate anticoagulation is optimal for hemodialysis in patients at high risk of bleeding: A prospective randomized study of three anticoagulation strategies

2019 ◽  
Author(s):  
Ting Lin ◽  
Li Song ◽  
Renwei Huang ◽  
Ying Huang ◽  
Shuifu Tang ◽  
...  
Keyword(s):  
High Risk ◽  
Randomized Study ◽  
Bleeding Risk ◽  
Saline Group ◽  
Regional Citrate Anticoagulation ◽  
Expansion Chamber ◽  
Citrate Anticoagulation ◽  
Risk Of Bleeding ◽  
Group 4 ◽  
High Bleeding Risk

Abstract ABSTRACT Background： Recommended regular saline flushing presents clinical ineffectiveness for hemodialysis (HD) patients at high risk of bleeding with heparin contraindication. Regional citrate anticoagulation (RCA) has previously been used with a Ca 2+ containing dialysate with prefiltered citrate in one arm (RCA-one). However, anticoagulation is not always achievable and up to 40% results in serious clotting in the venous expansion chamber. In this study, we have transferred one-quarter of the TSC from the prefiltered to the post filter based on RCA-one, which we have called RCA-two. The objective of this study was to compare the efficacy and safety of RCA-two with either saline flushing or RCA-one in HD patients with a high bleeding risk. Method ： In this investigator-initiated, multicenter, controlled, prospective, randomized clinical trial, 52 HD patients (77 sessions) were randomized to the RCA-two and RCA-one group in part one of the trial, and 45 patients (64 sessions) were randomized to the RCA-two and saline group in part two of the trial. Serious clotting events, adverse events and blood analyses were recorded. Results ：Serious clotting events in the RCA-two group were significantly lower compared with the RCA-one and saline group (7.89% vs. 30.77%, P = 0.011; 3.03% vs. 54.84%, P < 0.001, respectively). The median circuit survival time was 240 min (IQR 240 to 240) in the RCA-two group, was significantly longer than 230 min (IQR 155 to 240, P < 0.001) in the RCA-one group and 210 min (IQR 135 to 240，P = 0.003) in the saline group. The majority of the AEs were hypotension, hypoglycemia and chest tightness, most of which were mild in intensity. Eight patients (20.51%) in the RCA-one group, 4 patients (12.90%) in the saline group and 10 patients (26.31%) in the RCA-two group, P>0.05. Conclusions ： Our data demonstrated that the modified anticoagulation protocol was more effective and feasible during hemodialysis therapy for patients at high risk of bleeding. Trial registration: GDREC, GDREC2017250H. Registered February 2, 2018; prospectively registered.

scholarly journals Modified regional citrate anticoagulation is optimal for hemodialysis in patients at high risk of bleeding: A prospective randomized study of three anticoagulation strategies

2019 ◽  
Author(s):  
Ting Lin ◽  
Li Song ◽  
Renwei Huang ◽  
Ying Huang ◽  
Shuifu Tang ◽  
...  
Keyword(s):  
Clinical Trial ◽  
High Risk ◽  
Randomized Study ◽  
Bleeding Risk ◽  
Saline Group ◽  
Regional Citrate Anticoagulation ◽  
Expansion Chamber ◽  
Citrate Anticoagulation ◽  
Risk Of Bleeding ◽  
High Bleeding Risk

Abstract Background：The recommended regular saline flushing presents clinical ineffectiveness for patients at high risk of bleeding with heparin contraindication. Regional citrate anticoagulation (RCA) has been used in a Ca2+ containing dialysate with prefilter citrate in one arm (RCA-one). The anticoagulation effect was not realized, and up to 40% resulted in serious clotting in the venous expansion chamber. We innovatively transferred one-quarter of the TSC from the prefilter to the postfilter based on RCA-one, which is called RCA-two in this trial. The objective of this study was to compare the efficacy and safety of RCA-two with either saline flushing or RCA-one in HD patients with a high bleeding risk. Method：In this investigator-initiated, multicenter, placebo-controlled, prospective, randomized clinical trial, 52 patients (77 sessions) were randomized to the RCA-two and RCA-one group in part one trial, and 45 patients (64 sessions) were randomized to the RCA-two and Saline group in part two trial. Serious clotting events, adverse events and blood analyses were recorded. Results：The primary outcome, Serious clotting events in the RCA-two group were significantly lower than that in the RCA-one and Saline group (7.89% vs. 30.77%, P = 0.011; 3.03% vs. 54.84%, P < 0.001, respectively). The median circuit survival time was 240 min (IQR 240 to 240) in the RCA-two group, which was significantly longer than 230 min (IQR 155 to 240, P < 0.001) in the RCA-one group and 210 min (IQR 135 to 240，P = 0.003) in the Saline group. The majority of the AEs were hypotension, hypoglycemia and chest tightness, most of which were mild in intensity. Eight patients (20.51%) in the RCA-one group, 4 patients (12.90%) in the Saline group and 10 patients (26.31%) in the RCA-two group, P>0.05. Conclusions：Our data demonstrated that the modified anticoagulation protocol is more effective and feasible during hemodialysis therapy for patients at high risk of bleeding. Trial registration: GDREC, GDREC2017250H. Registered 2th February 2018-Retrospectively registered. Keywords: regional citrate anticoagulation, hemodialysis, high risk of bleeding, serious clotting, saline flushing, randomized prospective clinical trial.

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