Exploring clinical evaluation indicators for predicting coagulation in the extracorporeal circulation circuit in hemodialysis patients receiving individualized regional citrate anticoagulation-A single-center, retrospective clinical study.

IF 1.4 4区 医学 Q3 UROLOGY & NEPHROLOGY Seminars in Dialysis Pub Date : 2024-03-01 Epub Date: 2023-10-05 DOI:10.1111/sdi.13183
Menglin Zou, Feifei Wu, Yanna Fan, Yanyan Gong, Zhen Hu, Tin Jiang, Chenfu Gan, Laimin Luo
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Abstract

Background: Citrate anticoagulation is an important anticoagulation method in hemodialysis (HD) but cannot completely prevent the occurrence of coagulation in the extracorporeal circulation (ECC) circuit, and the clinical coagulation status can significantly affect the effect of citrate anticoagulation. In this study, the relationships between clinical coagulation status indicators and coagulation in the ECC circuit in HD patients receiving individualized citrate anticoagulant were studied to explore indicators that may predict coagulation in the ECC circuit.

Methods: This study was a single-center, retrospective clinical study, and clinical data and laboratory tests related to the coagulation status of HD patients receiving individualized regional citrate anticoagulation (RCA) were collected. The relationships between indicators commonly used in clinical practice to evaluate clinical coagulation status and coagulation in the ECC circuit were statistically analyzed to find indicators that can predict the occurrence of coagulation in the ECC circuit.

Results: The individualized RCA had a good anticoagulation effect, and the actual citrate infusion rate in nearly 80% of the patients was within ±10% of the theoretical infusion rate. The combined diseases or conditions that affect the coagulation status in vivo may increase the incidence of coagulation in the ECC circuit. The clinical D-dimer level is an independent risk factor that affects and can predict coagulation in the ECC circuit, with a cutoff value of 2.03 mg/L, sensitivity of 59%, and specificity of 78%.

Conclusion: Individualized RCA can meet the needs of most HD treatments. Abnormal coagulation status in HD patients may increase the incidence of coagulation in the ECC circuit during individualized RCA for HD, and the D-dimer level can predict the occurrence of coagulation in the ECC circuit during this treatment.

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探索预测接受个性化区域枸橼酸盐抗凝治疗的血液透析患者体外循环回路凝血的临床评估指标——一项单中心回顾性临床研究。
背景:柠檬酸盐抗凝是血液透析(HD)中一种重要的抗凝方法,但不能完全预防体外循环(ECC)回路中凝血的发生,临床凝血状态会显著影响柠檬酸盐的抗凝效果。在本研究中,研究了接受个体化柠檬酸盐抗凝剂治疗的HD患者的临床凝血状态指标与ECC回路中凝血之间的关系,以探索可能预测ECC回路中凝固的指标。方法:本研究是一项单中心回顾性临床研究,收集接受个体化局部枸橼酸盐抗凝治疗的HD患者的凝血状态相关的临床数据和实验室测试。对临床实践中常用的评估临床凝血状态的指标与ECC回路中的凝血之间的关系进行统计分析,以找到可以预测ECC回路中凝血发生的指标。结果:个体化RCA具有良好的抗凝效果,近80%的患者实际枸橼酸盐输注率在理论输注率的±10%以内。影响体内凝血状态的合并疾病或条件可能会增加ECC回路中凝血的发生率。临床D-二聚体水平是一个独立的风险因素,影响并可以预测ECC回路中的凝血,其临界值为2.03 mg/L,敏感性为59%,特异性为78%。结论:个性化RCA可以满足大多数HD治疗的需要。HD患者的异常凝血状态可能会增加HD个体化RCA期间ECC回路中凝血的发生率,并且D-二聚体水平可以预测该治疗期间ECC回路的凝血发生。
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来源期刊
Seminars in Dialysis
Seminars in Dialysis 医学-泌尿学与肾脏学
CiteScore
3.00
自引率
6.20%
发文量
91
审稿时长
4-8 weeks
期刊介绍: Seminars in Dialysis is a bimonthly publication focusing exclusively on cutting-edge clinical aspects of dialysis therapy. Besides publishing papers by the most respected names in the field of dialysis, the Journal has unique useful features, all designed to keep you current: -Fellows Forum -Dialysis rounds -Editorials -Opinions -Briefly noted -Summary and Comment -Guest Edited Issues -Special Articles Virtually everything you read in Seminars in Dialysis is written or solicited by the editors after choosing the most effective of nine different editorial styles and formats. They know that facts, speculations, ''how-to-do-it'' information, opinions, and news reports all play important roles in your education and the patient care you provide. Alternate issues of the journal are guest edited and focus on a single clinical topic in dialysis.
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