Objective: To evaluate the safety and efficacy of regional citrate anticoagulation in sustained low efficiency dialysis (SLED).
Methods: A total of 45 patients with acute kidney injury (AKI) or end stage renal disease (ESRD) admitted in our hospital from August 2011 to September 2012 were prospectively enrolled in this study. All the patients received SLED treatment by Fresenius 4008sARrTplus dialyzer through either femoral or internal jugular venous catheter, with each session of SLED treatment lasting for 8 hours. All the patients were pumped in 4% tri-sodium citrate solution through the arterial line at 130 ml/hour and 10% calcium gluconate through the venous line at 40 ml/hour. The blood flow was 150 ml/minute while the calcium-free dialysate was delivered at 200 ml/minute. Systemic citrate concentration, peripheral and post dialyzer ionized calcium levels at 0, 2 and 5 hour were recorded.
Results: All the 45 patients underwent 162 sessions of SLED with 2 were discontinued due to III° dialyzer coagulation, and other 160 SLED sessions (98.8%) were all successfully performed. The systemic citrate concentration at 0 hour was (0.14 ± 0.06) mmol/L, the systemic citrate concentrations at 2 and 5 hour were slightly increased while no statistical difference was found[(1.08 ± 0.12) mmol/L vs (1.11 ± 0.17) mmol/L, P > 0.05]. The 0, 2, 5 hour peripheral blood ionized calcium levels were (1.04 ± 0.13) mmol/L, (1.07 ± 0.23) mmol/L and (1.04 ± 0.24) mmol/L, respectively, with no significant difference (P > 0.05). The post dialyzer ionized calcium levels were (0.31 ± 0.04) mmol/L at 2 hour and (0.29 ± 0.03) mmol/L at 5 hour. The transmembrane pressure at 2 hour was (104.5 ± 17.8) mm Hg(1 mm Hg = 0.133 kPa), and (109.3 ± 20.1) mm Hg at 5 hour, however the increase was not of statistical significance (P > 0.05). At 5 hour, prothrombin time and activated partial thrombin time were identified to be similar to those before SLED. During the treatments, no bleeding complication, thrombocytopenia, cardiac arrhythmia, hypernatremia, metabolic alkalosis or hypotension was observed.
Conclusion: SLED under regional citrate anticoagulation is safe and effective. Citrate achieves satisfying regional anticoagulation effect without interfering systemic clotting function, thus this study provides a new option of SLED anticoagulation for clinicians.