Metabolic alkalosis induced by regional citrate anticoagulation in continuous renal replacement therapy: single-center retrospective study
10.3760/cma.j.issn.1671-0282.2025.02.014
- VernacularTitle:枸橼酸局部抗凝持续肾脏替代的代谢性碱中毒——一项单中心回顾性研究
- Author:
Hanqi TANG
1
;
Qinghong CUI
;
Jing SHI
;
Huadong ZHU
;
Xuezhong YU
;
Shengyong XU
;
Jun XU
Author Information
1. 中国医学科学院北京协和医学院，北京协和医院急诊科，疑难重症及罕见病国家重点实验室，北京 100730
- Keywords:
Continuous renal replacement therapy;
Citrate;
Anticoagulation;
Metabolic alkalosis;
Renal injury;
Risk factor;
Cohort study;
Mechanism
- From:
Chinese Journal of Emergency Medicine
2025;34(2):220-225
- CountryChina
- Language:Chinese
-
Abstract:
Objective:Metabolic alkalosis has raised concerns in patients receiving continuous renal replacement therapy (CRRT) via regional citrate anticoagulation (RCA). This study searched for alkalosis-related factors and mechanisms.Methods:It's a retrospective study of alkalosis in patients who received CRRT for at least 12 hours with RCA in a tertiary hospital between April 2017 and April 2020. Demographic features, baseline laboratory results, CRRT metrics and laboratory results at 12h after CRRT was recorded. Patients was grouped based on whether alkalosis exist at 12h after CRRT, and multivariable logistic regression analysis was used to identify risk factors for alkalosis during CRRT with citrate anticoagulation.Results:The 59 patients meeting the inclusion criteria were 49% male, with a mean age of (55±18) years old, and 42% had alkalosis by 12 hours after CRRT. No significant differences in demographic features or laboratory results were observed patients with or without alkalosis. CRRT metrics, including blood flow rate, citrate rate, replacement fluid rate and total effluent rate, were significantly different among groups ( P<0.01). Multivariable Logistic regression analysis indicated that the citrate rate was a risk factor for alkalosis ( OR=1.088, 95% CI 1.020-1.161, P =0.010). In patients receiving no NaHCO 3 and without alkalosis, the linear regression analysis described the relationships of citrate with replacement fluid rate (citrate rate = 0.090 × replacement fluid rate + 56.581; R2 = 0.6918) and total effluent rate (citrate rate = 0.099 × total effluent rate + 2.449). Conclusions:This retrospective observational study demonstrated that CRRT metrics are highly associated with alkalosis after 12 hours of CRRT. Without NaHCO3 infusion, a 10-fold linear correlation was observed between citrate and total effluent rate in patients without metabolic alkalosis.
