Calcium-containing versus calcium-free replacement solution in regional citrate anticoagulation for continuous renal replacement therapy:a randomized controlled trial  

作　　者：Tiantian Wei Xin Tang Ling Zhang Li Lin Peiyun Li Fang Wang Ping Fu 

机构地区：[1]Department of Nephrology,West China Hospital of Sichuan University,Chengdu,Sichuan 610041,China

出　　处：《Chinese Medical Journal》2022年第20期2478-2487,共10页中华医学杂志（英文版）

基　　金：1·3·5 project for disciplines of excellence-Clinical Research Incubation Project, West China Hospital, Sichuan University(18HXFH018)

摘　　要：Background: A simplified protocol for regional citrate anticoagulation (RCA) using a commercial calcium-containing replacement solution, without continuous calcium infusion, is more efficient for use in continuous renal replacement therapy (CRRT). We aim to design a randomized clinical trial to compare the safety and efficacy between calcium-free and calcium-containing replacement solutions in CRRT with RCA.Methods: Of the 64 patients receiving RCA-based postdilution continuous venovenous hemodiafiltration (CVVHDF) enrolled from 2017 to 2019 in West China Hospital of Sichuan University, 35 patients were randomized to the calcium-containing group and 29 to the calcium-free replacement solution group. The primary endpoint was circuit lifespan and Kaplan-Meier survival analysis was performed. Secondary endpoints included hospital mortality, kidney function recovery rate, and complications. The amount of 4% trisodium citrate solution infusion was recorded. Serum and effluent total (tCa) and ionized (iCa) calcium concentrations were measured during CVVHDF.Results: A total of 149 circuits (82 in the calcium-containing group and 67 in the calcium-free group) and 7609 circuit hours (4335 hvs. 3274 h) were included. The mean circuit lifespan was 58.1 h (95% CI 53.8-62.4 h) in the calcium-containing groupvs. 55.3 h (95% CI 49.7-60.9 h, log rankP = 0.89) in the calcium-free group. The serum tCa and iCa concentrations were slightly lower in the calcium-containing group during CRRT, whereas the postfilter iCa concentration was lower in the calcium-free group. Moreover, the mean amounts of 4% trisodium citrate solution infusion were not significantly different between the groups (171.1 ± 15.9 mL/hvs. 169.0 ± 15.1 mL/h,P = 0.49). The mortality (14/35 [40%]vs. 13/29 [45%],P = 0.70) and kidney function recovery rates of AKI patients (19/26, 73%vs. 14/24, 58%,P = 0.27) were comparable between the calcium-containing and calcium-free group during hospitalization, respectively. Six (three in each group) patients showed signs of cit

关 键 词：Anticoagulant agent Circuit lifespan Continuous renal replacement therapy Dialysis solutions Randomized controlled trial Sodium citrate 

分 类 号：R459.5[医药卫生—治疗学]