Modified regional citrate anticoagulation is optimal for hemodialysis in patients at high risk of bleeding: a prospective randomized study of three anticoagulation strategies
Abstract Background Recommended regular saline flushing presents clinical ineffectiveness for hemodialysis (HD) patients at high risk of bleeding with heparin contraindication. Regional citrate anticoagulation (RCA) has previously been used with a Ca2+ containing dialysate with prefiltered citrate i...
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BMC
2019-12-01
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Series: | BMC Nephrology |
Online Access: | https://doi.org/10.1186/s12882-019-1661-y |
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Article |
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DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Ting Lin Li Song Renwei Huang Ying Huang Shuifu Tang Qizhan Lin Ying Zhang Xingbo Wu Hui Liang Yuchi Wu Yuanhan Chen Huaban Liang Jianchao Ma Zhonglin Feng Zhuo Li Lixia Xu Xia Fu Zhiming Ye Shuangxin Liu Xinling Liang |
spellingShingle |
Ting Lin Li Song Renwei Huang Ying Huang Shuifu Tang Qizhan Lin Ying Zhang Xingbo Wu Hui Liang Yuchi Wu Yuanhan Chen Huaban Liang Jianchao Ma Zhonglin Feng Zhuo Li Lixia Xu Xia Fu Zhiming Ye Shuangxin Liu Xinling Liang Modified regional citrate anticoagulation is optimal for hemodialysis in patients at high risk of bleeding: a prospective randomized study of three anticoagulation strategies BMC Nephrology |
author_facet |
Ting Lin Li Song Renwei Huang Ying Huang Shuifu Tang Qizhan Lin Ying Zhang Xingbo Wu Hui Liang Yuchi Wu Yuanhan Chen Huaban Liang Jianchao Ma Zhonglin Feng Zhuo Li Lixia Xu Xia Fu Zhiming Ye Shuangxin Liu Xinling Liang |
author_sort |
Ting Lin |
title |
Modified regional citrate anticoagulation is optimal for hemodialysis in patients at high risk of bleeding: a prospective randomized study of three anticoagulation strategies |
title_short |
Modified regional citrate anticoagulation is optimal for hemodialysis in patients at high risk of bleeding: a prospective randomized study of three anticoagulation strategies |
title_full |
Modified regional citrate anticoagulation is optimal for hemodialysis in patients at high risk of bleeding: a prospective randomized study of three anticoagulation strategies |
title_fullStr |
Modified regional citrate anticoagulation is optimal for hemodialysis in patients at high risk of bleeding: a prospective randomized study of three anticoagulation strategies |
title_full_unstemmed |
Modified regional citrate anticoagulation is optimal for hemodialysis in patients at high risk of bleeding: a prospective randomized study of three anticoagulation strategies |
title_sort |
modified regional citrate anticoagulation is optimal for hemodialysis in patients at high risk of bleeding: a prospective randomized study of three anticoagulation strategies |
publisher |
BMC |
series |
BMC Nephrology |
issn |
1471-2369 |
publishDate |
2019-12-01 |
description |
Abstract Background Recommended regular saline flushing presents clinical ineffectiveness for hemodialysis (HD) patients at high risk of bleeding with heparin contraindication. Regional citrate anticoagulation (RCA) has previously been used with a Ca2+ containing dialysate with prefiltered citrate in one arm (RCA-one). However, anticoagulation is not always achievable and up to 40% results in serious clotting in the venous expansion chamber. In this study, we have transferred one-quarter of the TSC from the prefiltered to the post filter based on RCA-one, which we have called RCA-two. The objective of this study was to compare the efficacy and safety of RCA-two with either saline flushing or RCA-one in HD patients with a high bleeding risk. Method In this investigator-initiated, multicenter, controlled, prospective, randomized clinical trial, 52 HD patients (77 sessions) were randomized to the RCA-2 and RCA-one group in part one of the trial, and 45 patients (64 sessions) were randomized to the RCA-2 and saline group in part two of the trial. Serious clotting events, adverse events and blood analyses were recorded. Results Serious clotting events in the RCA-two group were significantly lower compared with the RCA-one and saline group (7.89% vs. 30.77%, P = 0.011; 3.03% vs. 54.84%, P < 0.001, respectively). The median circuit survival time was 240 min (IQR 240 to 240) in the RCA-two group, was significantly longer than 230 min (IQR 155 to 240, P < 0.001) in the RCA-one group and 210 min (IQR 135 to 240, P = 0.003) in the saline group. The majority of the AEs were hypotension, hypoglycemia and chest tightness, most of which were mild in intensity. Eight patients (20.51%) in the RCA-one group, 4 patients (12.90%) in the saline group and 10 patients (26.31%) in the RCA-two group, P > 0.05. Conclusions Our data demonstrated that the modified anticoagulation protocol was more effective and feasible during hemodialysis therapy for patients at high risk of bleeding. Trial registration GDREC, GDREC2017250H. Registered February 2, 2018; retrospectively registered. |
url |
https://doi.org/10.1186/s12882-019-1661-y |
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doaj-9b675cdb53b24719834e9a76b9a892982020-12-20T12:39:16ZengBMCBMC Nephrology1471-23692019-12-0120111410.1186/s12882-019-1661-yModified regional citrate anticoagulation is optimal for hemodialysis in patients at high risk of bleeding: a prospective randomized study of three anticoagulation strategiesTing Lin0Li Song1Renwei Huang2Ying Huang3Shuifu Tang4Qizhan Lin5Ying Zhang6Xingbo Wu7Hui Liang8Yuchi Wu9Yuanhan Chen10Huaban Liang11Jianchao Ma12Zhonglin Feng13Zhuo Li14Lixia Xu15Xia Fu16Zhiming Ye17Shuangxin Liu18Xinling Liang19Department of Nephrology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical SciencesDepartment of Nephrology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical SciencesDepartment of Nephrology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical SciencesDepartment of Nephrology, The Second Affiliated Hospital of Guangzhou Medical UniversityDepartment of Nephrology, First Affiliated Hospital of Guangzhou University of Chinese MedicineDepartment of Hemodialysis, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou University of Chinese MedicineDepartment of Nephrology, The Second Affiliated Hospital of Guangzhou Medical UniversityDepartment of Nephrology, First Affiliated Hospital of Guangzhou University of Chinese MedicineDepartment of Hemodialysis, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou University of Chinese MedicineDepartment of Hemodialysis, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou University of Chinese MedicineDepartment of Nephrology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical SciencesDepartment of Nephrology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical SciencesDepartment of Nephrology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical SciencesDepartment of Nephrology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical SciencesDepartment of Nephrology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical SciencesDepartment of Nephrology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical SciencesDepartment of Nephrology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical SciencesDepartment of Nephrology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical SciencesDepartment of Nephrology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical SciencesDepartment of Nephrology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical SciencesAbstract Background Recommended regular saline flushing presents clinical ineffectiveness for hemodialysis (HD) patients at high risk of bleeding with heparin contraindication. Regional citrate anticoagulation (RCA) has previously been used with a Ca2+ containing dialysate with prefiltered citrate in one arm (RCA-one). However, anticoagulation is not always achievable and up to 40% results in serious clotting in the venous expansion chamber. In this study, we have transferred one-quarter of the TSC from the prefiltered to the post filter based on RCA-one, which we have called RCA-two. The objective of this study was to compare the efficacy and safety of RCA-two with either saline flushing or RCA-one in HD patients with a high bleeding risk. Method In this investigator-initiated, multicenter, controlled, prospective, randomized clinical trial, 52 HD patients (77 sessions) were randomized to the RCA-2 and RCA-one group in part one of the trial, and 45 patients (64 sessions) were randomized to the RCA-2 and saline group in part two of the trial. Serious clotting events, adverse events and blood analyses were recorded. Results Serious clotting events in the RCA-two group were significantly lower compared with the RCA-one and saline group (7.89% vs. 30.77%, P = 0.011; 3.03% vs. 54.84%, P < 0.001, respectively). The median circuit survival time was 240 min (IQR 240 to 240) in the RCA-two group, was significantly longer than 230 min (IQR 155 to 240, P < 0.001) in the RCA-one group and 210 min (IQR 135 to 240, P = 0.003) in the saline group. The majority of the AEs were hypotension, hypoglycemia and chest tightness, most of which were mild in intensity. Eight patients (20.51%) in the RCA-one group, 4 patients (12.90%) in the saline group and 10 patients (26.31%) in the RCA-two group, P > 0.05. Conclusions Our data demonstrated that the modified anticoagulation protocol was more effective and feasible during hemodialysis therapy for patients at high risk of bleeding. Trial registration GDREC, GDREC2017250H. Registered February 2, 2018; retrospectively registered.https://doi.org/10.1186/s12882-019-1661-y |