Application of regional citrate anticoagulation in patients at high risk of bleeding during intermittent hemodialysis: a prospective multicenter randomized controlled trial.

Xiaoyan Tang; Dezheng Chen; Ling Zhang; Ping FU; Yanxia Chen; Zhou Xiao; Xiangcheng Xiao; Weisheng Peng; Li Cheng; Yanmin Zhang; Hongbo LI; Kehui LI; Bizhen Gou; Xin WU; Qian YU; Lijun Jian; Zaizhi Zhu; Yu Wen; Cheng Liu; Hen Xue; Hongyu Zhang; Xin HE; Bin Yan; Liping Zhong; Bin Huang; Mingying Mao

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Application of regional citrate anticoagulation in patients at high risk of bleeding during intermittent hemodialysis: a prospective multicenter randomized controlled trial.

Author: Xiaoyan TANG ¹ ; Dezheng CHEN ² ; Ling ZHANG ³ ; Ping FU ¹ ; Yanxia CHEN ⁴ ; Zhou XIAO ⁵ ; Xiangcheng XIAO ⁵ ; Weisheng PENG ⁵ ; Li CHENG ⁶ ; Yanmin ZHANG ⁶ ; Hongbo LI ⁶ ; Kehui LI ⁷ ; Bizhen GOU ⁸ ; Xin WU ⁸ ; Qian YU ⁸ ; Lijun JIAN ⁹ ; Zaizhi ZHU ¹⁰ ; Yu WEN ¹¹ ; Cheng LIU ¹¹ ; Hen XUE ¹² ; Hongyu ZHANG ¹² ; Xin HE ¹³ ; Bin YAN ¹⁴ ; Liping ZHONG ⁵ ; Bin HUANG ⁵ ; Mingying MAO ²
Author Information

1. Division of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu 610041, China.
2. Department of Nephrology, People's Hospital of Jianyang City, Chengdu 641400, China.
3. Division of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu 610041, China. zhangling_crrt@163.com.
4. Department of Nephrology, the Second Affiliated Hospital of Nanchang University, Nanchang 330006, China.
5. Department of Nephrology, Xiangya Hospital of Central South University, Changsha 410008, China.
6. Department of Nephrology, Wuhan No. 1 Hospital, Wuhan 430022, China.
7. Department of Blood Purification, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China.
8. Department of Nephrology, Guiyang First People's Hospital, Guiyang 550002, China.
9. Department of Nephrology, West China Hospital Sichuan University Jintang Hospital, Jintang 610400, China.
10. Department of Nephrology, Meishan People's Hospital, Meishan 620020, China.
11. Department of Nephrology, Ziyang People's Hospital, Ziyang 641300, China.
12. Department of Nephrology, Ya'an People's Hospital, Ya'an 625000, China.
13. Department of Nephrology, Chengdu Kangfu Kidney Disease Hospital, Chengdu 610047, China.
14. Department of Nephrology, the First People's Hospital of Liangshan Yi Autonomous Prefecture, Xichang 615000, China.
Publication Type:Journal Article
Keywords: Anticoagulation; Calcium-containing dialysate; Intermittent hemodialysis; Regional citrate anticoagulation; Saline flushing
MeSH: Humans; Citric Acid/adverse effects*; Prospective Studies; Sodium Citrate; Hemorrhage/chemically induced*; Citrates/adverse effects*; Anticoagulants/adverse effects*; Renal Dialysis/adverse effects*
From: Journal of Zhejiang University. Science. B 2022;23(11):931-942
CountryChina
Language:English
Abstract: OBJECTIVES:Safe and effective anticoagulation is essential for hemodialysis patients who are at high risk of bleeding. The purpose of this trial is to evaluate the effectiveness and safety of two-stage regional citrate anticoagulation (RCA) combined with sequential anticoagulation and standard calcium-containing dialysate in intermittent hemodialysis (IHD) treatment.
METHODS:Patients at high risk of bleeding who underwent IHD from September 2019 to May 2021 were prospectively enrolled in 13 blood purification centers of nephrology departments, and were randomly divided into RCA group and saline flushing group. In the RCA group, 0.04 g/mL sodium citrate was infused from the start of the dialysis line during blood draining and at the venous expansion chamber. The sodium citrate was stopped after 3 h of dialysis, which was changed to sequential dialysis without anticoagulant. The hazard ratios for coagulation were according to baseline.
RESULTS:A total of 159 patients and 208 sessions were enrolled, including RCA group (80 patients, 110 sessions) and saline flushing group (79 patients, 98 sessions). The incidence of severe coagulation events of extracorporeal circulation in the RCA group was significantly lower than that in the saline flushing group (3.64% vs. 20.41%, P<0.001). The survival time of the filter pipeline in the RCA group was significantly longer than that in the saline flushing group ((238.34±9.33) min vs. (221.73±34.10) min, P<0.001). The urea clearance index (Kt/V) in the RCA group was similar to that in the saline flushing group with no statistically significant difference (1.12±0.34 vs. 1.08±0.34, P=0.41).
CONCLUSIONS:Compared with saline flushing, the two-stage RCA combined with a sequential anticoagulation strategy significantly reduced extracorporeal circulation clotting events and prolonged the dialysis time without serious adverse events.