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Abstract：
BACKGROUND: Regional citrate anticoagulation (RCA) is recommended during continuous renal replacement therapy. Compared to systemic anticoagulation, RCA provides a longer filter lifespan with the risk of metabolic alkalosis and impaired calcium homeostasis. Surprisingly, most RCA protocols are designed for continuous veno-venous hemodialysis or hemodiafiltration. Effective protocols for continuous veno-venous hemofiltration (CVVH) are rare, although CVVH is a standard treatment for high-molecular-weight clearance. Therefore, we evaluated a new RCA protocol for postdilution CVVH.
METHODS: This is a monocentric prospective interventional study to evaluate a new RCA protocol for postdilution CVVH. We recruited surgical patients with stage III acute kidney injury who needed renal replacement therapy. We recorded dialysis and RCA data and hemodynamic and laboratory parameters during treatment sessions of 72 h. The primary endpoint was filter patency at 72 h. The major safety parameters were metabolic alkalosis and severe hypocalcemia at any time.
RESULTS: We included 38 patients who underwent 66 treatment sessions. The mean filter lifespan was 66 ± 12 h, and 44 of 66 (66%) filters were patent at 72 h. After censoring for non-CVVH-related cessation of treatment, 83% of all filters were patent at 72 h. The delivered dialysis dose was 28 ± 5 ml/kgBW/h. The serum levels of creatinine, urea and beta2-microglobulin decreased significantly from day 0 to day 3. Metabolic alkalosis occurred in one patient. An iCa++ below 1.0 mmol/L occurred in four patients. Citrate accumulation did not occur.
CONCLUSIONS: We describe a safe, effective, and easy-to-use RCA protocol for postdilution CVVH. This protocol provides a long and sustained filter lifespan without serious adverse effects. The risk of metabolic alkalosis and hypocalcemia is low. Using this protocol, a recommended dialysis dose can be safely administered with effective clearance of low- and middle-molecular-weight molecules.
BACKGROUND: The study was approved by the medical ethics committee of Heinrich-Heine University Duesseldorf (No. 2018-82KFogU). The trial was registered in the local study register of the university (No: 2018044660) on 07/04/2018 and was retrospectively registered at ClinicalTrials.gov (ClinicalTrials.gov Identifier: NCT03969966) on 31/05/2019.
METHODS: This is a monocentric prospective interventional study to evaluate a new RCA protocol for postdilution CVVH. We recruited surgical patients with stage III acute kidney injury who needed renal replacement therapy. We recorded dialysis and RCA data and hemodynamic and laboratory parameters during treatment sessions of 72 h. The primary endpoint was filter patency at 72 h. The major safety parameters were metabolic alkalosis and severe hypocalcemia at any time.
RESULTS: We included 38 patients who underwent 66 treatment sessions. The mean filter lifespan was 66 ± 12 h, and 44 of 66 (66%) filters were patent at 72 h. After censoring for non-CVVH-related cessation of treatment, 83% of all filters were patent at 72 h. The delivered dialysis dose was 28 ± 5 ml/kgBW/h. The serum levels of creatinine, urea and beta2-microglobulin decreased significantly from day 0 to day 3. Metabolic alkalosis occurred in one patient. An iCa++ below 1.0 mmol/L occurred in four patients. Citrate accumulation did not occur.
CONCLUSIONS: We describe a safe, effective, and easy-to-use RCA protocol for postdilution CVVH. This protocol provides a long and sustained filter lifespan without serious adverse effects. The risk of metabolic alkalosis and hypocalcemia is low. Using this protocol, a recommended dialysis dose can be safely administered with effective clearance of low- and middle-molecular-weight molecules.
BACKGROUND: The study was approved by the medical ethics committee of Heinrich-Heine University Duesseldorf (No. 2018-82KFogU). The trial was registered in the local study register of the university (No: 2018044660) on 07/04/2018 and was retrospectively registered at ClinicalTrials.gov (ClinicalTrials.gov Identifier: NCT03969966) on 31/05/2019.
摘要：
背景：在连续肾脏替代治疗期间，建议使用局部枸橼酸抗凝（RCA）。与全身抗凝相比，RCA提供更长的过滤器寿命，具有代谢性碱中毒和钙稳态受损的风险。令人惊讶的是,大多数RCA方案是为连续静脉-静脉血液透析或血液透析滤过而设计的.连续静脉-静脉血液滤过（CVVH）的有效方案很少见，尽管CVVH是高分子量清除的标准治疗方法。因此,我们评估了稀释后CVVH的新RCA方案。
方法：这是一项单中心前瞻性介入研究，旨在评估稀释后CVVH的新RCA方案。我们招募了需要肾脏替代治疗的III期急性肾损伤手术患者。我们记录了72h治疗期间的透析和RCA数据以及血液动力学和实验室参数。主要终点是72h时的过滤器通畅。主要安全参数是代谢性碱中毒和严重的低钙血症。
结果：我们纳入了38例接受66次治疗的患者。过滤器的平均寿命为66±12小时，在72小时时，66个过滤器中有44个（66％）是专利。在审查非CVVH相关的治疗停止后，所有过滤器的83%在72小时时通畅。递送的透析剂量为28±5ml/kgBW/h。血清肌酐水平,尿素和β2-微球蛋白从第0天到第3天显着降低。1例患者发生代谢性碱中毒。4例患者发生iCa++低于1.0mmol/L。没有发生柠檬酸盐积累。
结论：我们描述了一种安全的，有效,和易于使用的RCA方案后稀释CVVH。该方案提供了一个长期和持续的过滤器寿命没有严重的不利影响。代谢性碱中毒和低钙血症的风险较低。使用这个协议，推荐的透析剂量可以安全地给药，有效清除中低分子量分子。
背景：该研究得到了Heinrich-Heine大学杜塞尔多夫医学伦理委员会的批准（编号：2018-82KFogU）。该试验于2018年4月7日在该大学的当地研究登记册（编号：2018044660）中注册，并于2019年5月31日在ClinicalTrials.gov（ClinicalTrials.gov标识符：NCT03969966）进行回顾性注册。
方法：这是一项单中心前瞻性介入研究，旨在评估稀释后CVVH的新RCA方案。我们招募了需要肾脏替代治疗的III期急性肾损伤手术患者。我们记录了72h治疗期间的透析和RCA数据以及血液动力学和实验室参数。主要终点是72h时的过滤器通畅。主要安全参数是代谢性碱中毒和严重的低钙血症。
结果：我们纳入了38例接受66次治疗的患者。过滤器的平均寿命为66±12小时，在72小时时，66个过滤器中有44个（66％）是专利。在审查非CVVH相关的治疗停止后，所有过滤器的83%在72小时时通畅。递送的透析剂量为28±5ml/kgBW/h。血清肌酐水平,尿素和β2-微球蛋白从第0天到第3天显着降低。1例患者发生代谢性碱中毒。4例患者发生iCa++低于1.0mmol/L。没有发生柠檬酸盐积累。
结论：我们描述了一种安全的，有效,和易于使用的RCA方案后稀释CVVH。该方案提供了一个长期和持续的过滤器寿命没有严重的不利影响。代谢性碱中毒和低钙血症的风险较低。使用这个协议，推荐的透析剂量可以安全地给药，有效清除中低分子量分子。
背景：该研究得到了Heinrich-Heine大学杜塞尔多夫医学伦理委员会的批准（编号：2018-82KFogU）。该试验于2018年4月7日在该大学的当地研究登记册（编号：2018044660）中注册，并于2019年5月31日在ClinicalTrials.gov（ClinicalTrials.gov标识符：NCT03969966）进行回顾性注册。
