典型文献
Calcium-containing versus calcium-free replacement solution in regional citrate anticoagulation for continuous renal replacement therapy: a randomized controlled trial
文献摘要：
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 h
vs. 3274 h) were included. The mean circuit lifespan was 58.1 h (95% CI 53.8-62.4 h) in the calcium-containing group
vs. 55.3 h (95% CI 49.7-60.9 h, log rank
P = 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/h
vs. 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 citrate accumulation in this study.
Conclusions::When compared with calcium-free replacement solution, RCA-based CVVHDF with calcium-containing replacement solution had a similar circuit lifespan, hospital mortality and kidney outcome. Since the calcium-containing solution obviates the need for a separate venous catheter and a large dose of intravenous calcium solution preparation for continuous calcium supplementation, it is more convenient to be applied in RCA-CRRT practice.Registration::Chinese Clinical Trial Registry (
, ChiCTR-IPR-17012629)
文献关键词：
Anticoagulant agent;Circuit lifespan;Continuous renal replacement therapy;Dialysis solutions;Randomized controlled trial;Sodium citrate
中图分类号：
作者姓名：
Wei Tiantian;Tang Xin;Zhang Ling;Lin Li;Li Peiyun;Wang Fang;Fu Ping
作者机构：
Department of Nephrology, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
文献出处：
引用格式：
[1]Wei Tiantian;Tang Xin;Zhang Ling;Lin Li;Li Peiyun;Wang Fang;Fu Ping-.Calcium-containing versus calcium-free replacement solution in regional citrate anticoagulation for continuous renal replacement therapy: a randomized controlled trial)[J].中华医学杂志（英文版）,2022(20):2478-2487
A类：
postdilution,trisodium,tCa,postfilter,obviates,Anticoagulant
B类：
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AB值：
0.419233
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