{"title":"比较稀释前和稀释后在线血液透析中的枸橼酸透析液:对血液透析患者血凝块形成和透析充分性的影响。","authors":"Pasu Nakornchai, Arisara Jitraree, Monpinya Charttong Homjan, Thanachit Laykhram, Thananda Trakarnvanich","doi":"10.1080/0886022X.2024.2302109","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Citrate dialysate (CD) has been successfully used in conventional hemodialysis and continuous renal replacement therapy; however, no study has compared pre- and post-dilution online hemodiafiltration (oL-HDF). Therefore, we aimed to investigate the efficacy of citrate anticoagulation for oL-HDF and the metabolic changes and quality of life of patients on hemodialysis treated using both modes.</p><p><strong>Method: </strong>Eight dialysis patients were treated with CD containing 0.8 mmol of citric acid for 4 weeks in each phase. Visual clotting scores were investigated as the primary endpoints. Adequacy of dialysis, laboratory parameters, and quality of life were measured as secondary objectives.</p><p><strong>Results: </strong>The mean clotting scores in the pre-dilution mode were significantly lower than those in the post-dilution mode and in all phases except the heparin-free phase (<i>p</i> < 0.001 in the baseline phase, <i>p</i> = 0.001 in phase 1, and <i>p</i> = 0.023 in phase 2). The values of Kt/V in both modalities were comparable except during the baseline phase, in which the values of pre-dilution were significantly greater than post-dilution (2.36 ± 0.52/week vs. 1.87 ± 0.33/week;95% CI -0.81 to -0.19, <i>p</i> = 0.002). The patient's quality of life regarding their physical activity level was significantly higher in the post-dilution mode than in the pre-dilution mode at baseline and in phase 1 (<i>p</i> = 0.014 and 0.004 at baseline and in phase 1, respectively). Metabolic changes did not differ between the two modes.</p><p><strong>Conclusion: </strong>Citrate dialysate decreased or prevented anticoagulation in both pre- and post-dilution modes of oL-HDF without significant side effects and had comparable adequacy of dialysis.</p>","PeriodicalId":20839,"journal":{"name":"Renal Failure","volume":null,"pages":null},"PeriodicalIF":3.0000,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10776067/pdf/","citationCount":"0","resultStr":"{\"title\":\"Comparison of citrate dialysate in pre- and post-dilution online hemodiafiltration: effect on clot formation and adequacy of dialysis in hemodialysis patients.\",\"authors\":\"Pasu Nakornchai, Arisara Jitraree, Monpinya Charttong Homjan, Thanachit Laykhram, Thananda Trakarnvanich\",\"doi\":\"10.1080/0886022X.2024.2302109\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Citrate dialysate (CD) has been successfully used in conventional hemodialysis and continuous renal replacement therapy; however, no study has compared pre- and post-dilution online hemodiafiltration (oL-HDF). Therefore, we aimed to investigate the efficacy of citrate anticoagulation for oL-HDF and the metabolic changes and quality of life of patients on hemodialysis treated using both modes.</p><p><strong>Method: </strong>Eight dialysis patients were treated with CD containing 0.8 mmol of citric acid for 4 weeks in each phase. Visual clotting scores were investigated as the primary endpoints. Adequacy of dialysis, laboratory parameters, and quality of life were measured as secondary objectives.</p><p><strong>Results: </strong>The mean clotting scores in the pre-dilution mode were significantly lower than those in the post-dilution mode and in all phases except the heparin-free phase (<i>p</i> < 0.001 in the baseline phase, <i>p</i> = 0.001 in phase 1, and <i>p</i> = 0.023 in phase 2). The values of Kt/V in both modalities were comparable except during the baseline phase, in which the values of pre-dilution were significantly greater than post-dilution (2.36 ± 0.52/week vs. 1.87 ± 0.33/week;95% CI -0.81 to -0.19, <i>p</i> = 0.002). The patient's quality of life regarding their physical activity level was significantly higher in the post-dilution mode than in the pre-dilution mode at baseline and in phase 1 (<i>p</i> = 0.014 and 0.004 at baseline and in phase 1, respectively). Metabolic changes did not differ between the two modes.</p><p><strong>Conclusion: </strong>Citrate dialysate decreased or prevented anticoagulation in both pre- and post-dilution modes of oL-HDF without significant side effects and had comparable adequacy of dialysis.</p>\",\"PeriodicalId\":20839,\"journal\":{\"name\":\"Renal Failure\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":3.0000,\"publicationDate\":\"2024-12-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10776067/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Renal Failure\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1080/0886022X.2024.2302109\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/1/8 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"UROLOGY & NEPHROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Renal Failure","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1080/0886022X.2024.2302109","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/1/8 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景:枸橼酸透析液(CD)已成功用于常规血液透析和连续性肾脏替代疗法;然而,还没有研究对稀释前和稀释后在线血液透析滤过(oL-HDF)进行比较。因此,我们旨在研究枸橼酸盐抗凝对 oL-HDF 的疗效,以及使用这两种模式治疗的血液透析患者的代谢变化和生活质量:方法:8 名透析患者在每个阶段接受为期 4 周的含 0.8 mmol 柠檬酸的 CD 治疗。视觉凝血评分作为主要终点进行调查。透析的充分性、实验室参数和生活质量作为次要目标进行测量:结果:稀释前模式下的平均凝血分数明显低于稀释后模式下的平均凝血分数,除无肝素阶段外,所有阶段的平均凝血分数都明显低于无肝素阶段(第一阶段 p = 0.001,第二阶段 p = 0.023)。除基线阶段外,两种模式的 Kt/V 值相当,稀释前的 Kt/V 值明显高于稀释后的 Kt/V 值(2.36 ± 0.52/week vs. 1.87 ± 0.33/week;95% CI -0.81 to -0.19,p = 0.002)。在基线和第一阶段,稀释后模式下患者的身体活动水平生活质量明显高于稀释前模式(基线和第一阶段分别为 p = 0.014 和 0.004)。两种模式的代谢变化没有差异:结论:枸橼酸透析液可减少或防止oL-HDF稀释前和稀释后两种模式下的抗凝,且无明显副作用,透析充分性相当。
Comparison of citrate dialysate in pre- and post-dilution online hemodiafiltration: effect on clot formation and adequacy of dialysis in hemodialysis patients.
Background: Citrate dialysate (CD) has been successfully used in conventional hemodialysis and continuous renal replacement therapy; however, no study has compared pre- and post-dilution online hemodiafiltration (oL-HDF). Therefore, we aimed to investigate the efficacy of citrate anticoagulation for oL-HDF and the metabolic changes and quality of life of patients on hemodialysis treated using both modes.
Method: Eight dialysis patients were treated with CD containing 0.8 mmol of citric acid for 4 weeks in each phase. Visual clotting scores were investigated as the primary endpoints. Adequacy of dialysis, laboratory parameters, and quality of life were measured as secondary objectives.
Results: The mean clotting scores in the pre-dilution mode were significantly lower than those in the post-dilution mode and in all phases except the heparin-free phase (p < 0.001 in the baseline phase, p = 0.001 in phase 1, and p = 0.023 in phase 2). The values of Kt/V in both modalities were comparable except during the baseline phase, in which the values of pre-dilution were significantly greater than post-dilution (2.36 ± 0.52/week vs. 1.87 ± 0.33/week;95% CI -0.81 to -0.19, p = 0.002). The patient's quality of life regarding their physical activity level was significantly higher in the post-dilution mode than in the pre-dilution mode at baseline and in phase 1 (p = 0.014 and 0.004 at baseline and in phase 1, respectively). Metabolic changes did not differ between the two modes.
Conclusion: Citrate dialysate decreased or prevented anticoagulation in both pre- and post-dilution modes of oL-HDF without significant side effects and had comparable adequacy of dialysis.
期刊介绍:
Renal Failure primarily concentrates on acute renal injury and its consequence, but also addresses advances in the fields of chronic renal failure, hypertension, and renal transplantation. Bringing together both clinical and experimental aspects of renal failure, this publication presents timely, practical information on pathology and pathophysiology of acute renal failure; nephrotoxicity of drugs and other substances; prevention, treatment, and therapy of renal failure; renal failure in association with transplantation, hypertension, and diabetes mellitus.