PDF(Pubmed)
Abstract：
Regional Citrate Anticoagulation (RCA) is considered the first-line anticoagulation for Continuous Kidney Replacement Therapy (CKRT). The RCA requires strict protocols and trained staff to avoid unsafe use and ensure its benefit. We have analyzed all our CKRT prescriptions from December 2020 to April 2022 anonymously, collecting data on CKRT, lab tests, clinical conditions, and complications of RCA. In addition, in order to better detect citrate accumulation, we have performed an RCA protocol by reducing the CaTot/Ca2+ ratio cut-off from 2.50 to 2.40 and increasing the number of calcium checks according to its trend. Among the 374 patients in CKRT, 104 received RCA prescriptions, of which 11 (10.6%) were discontinued: 4 for the suspicion of citrate accumulation, 1 for the development of metabolic alkalosis, 1 for the shift to a different CKRT procedure due to the need for a higher bicarbonate dose, 4 for the elevation of hepatocytolysis indexes, and 1 due to a preemptive discontinuation following massive post-surgery bleeding. None of the patients have had citrate toxicity as indicated by a CaTot/Ca2+ greater than 2.50, and our protocol has allowed the early identification of patients who might develop clinical citrate toxicity.
摘要：
局部柠檬酸抗凝（RCA）被认为是连续肾脏替代治疗（CKRT）的一线抗凝药物。RCA需要严格的协议和训练有素的员工，以避免不安全的使用并确保其利益。我们匿名分析了从2020年12月到2022年4月的所有CKRT处方，在CKRT上收集数据，实验室测试,临床状况,和RCA的并发症。此外,为了更好地检测柠檬酸盐的积累，我们通过将CaTot/Ca2+比值cut-off从2.50降低至2.40,并根据其趋势增加钙检查的数量来执行RCA方案.在374名CKRT患者中，104份收到RCA处方，其中11人(10.6%)停产:4人怀疑柠檬酸盐积累，1用于代谢性碱中毒的发展，1由于需要更高的碳酸氢盐剂量而转向不同的CKRT程序，4为肝细胞溶解指数的升高，和1是由于手术后大量出血后先发制人停药。如CaTot/Ca2+大于2.50所示,没有患者具有柠檬酸盐毒性,并且我们的方案允许早期识别可能产生临床柠檬酸盐毒性的患者。
