The possibility of using effluent ionized calcium to assess regional citrate anticoagulation in continuous renal replacement therapy
The possibility of using effluent ionized calcium to assess regional citrate anticoagulation in continuous renal replacement therapy
复制标题
使用流出离子钙评估连续肾脏替代治疗中局部柠檬酸盐抗凝作用的可能性
DOI：
10.1177/0391398819894595
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发表时间：
2019-12-18
影响因子：
1.7
通讯作者：
Ding，Feng
中科院分区：
文献类型：
--
作者：
Zhang，Qi;Zhuang，Feng;Ding，Feng
目的：本研究旨在研究流出液离子钙是否是评估连续性肾脏替代治疗中局部柠檬酸盐抗凝而非滤器后离子钙抗凝效果的适当指标。研究方法：总共从需要连续性肾脏替代治疗的重症患者中获得了48对流出液和滤器后血液样本。采集所有样本进行离子钙测量，并通过床旁分析仪进行评估。两种方法的相关性和一致性分别用Pearson线性分析和Bland-Altman分析。结果：滤器后平均离子钙为0.42 ± 0.12 mmol/L，流出液平均离子钙水平为0.39 ± 0.11 mmol/L。在所有连续性肾脏替代治疗患者中，流出液的离子钙水平与滤器后离子钙显著相关。Bland-Altman分析显示，在所有连续性肾脏替代治疗患者中，两个采样部位之间离子钙的平均差异为−0.02 mmol/L，95%置信区间范围为−0.09至0.04 mmol/L。连续性静脉-静脉血液滤过、连续性静脉-静脉血液透析和连续性静脉-静脉血液透析滤过模式也分别表现出显着的相关性和一致性。结论：流出液离子钙可作为滤器后离子钙的重要替代品，用于监测连续性肾脏替代治疗中局部柠檬酸盐抗凝的有效性，且失血量较少。
Aim: This study aimed to investigate whether effluent ionized calcium was an appropriate indicator to assess anticoagulant effect in continuous renal replacement therapy with regional citrate anticoagulation instead of post-filter ionized calcium. Methods: In total, 48 paired samples of effluent fluid and post-filter blood were obtained from critically ill patients who required continuous renal replacement therapy. All samples were taken for ionized calcium measurements and were assessed by point-of-care analyzer. Correlations and agreements between two methods were performed by Pearson linear analysis and Bland–Altman analysis accordingly. Results: The mean post-filter ionized calcium was 0.42 ± 0.12 mmol/L, and mean ionized calcium level of effluent fluid was 0.39 ± 0.11 mmol/L. The ionized calcium level of effluent fluid was significantly correlated with post-filter ionized calcium in all continuous renal replacement therapy patients. Bland–Altman analysis showed that the mean difference of ionized calcium between two sampling sites in all continuous renal replacement therapy patients was −0.02 mmol/L with 95% confidence interval ranging from −0.09 to 0.04 mmol/L. The significant correlations and agreements were also demonstrated in continuous veno-venous hemofiltration, continuous veno-venous hemodialysis, and continuous veno-venous hemodiafiltration modalities separately. Conclusion: The effluent ionized calcium could be a considerable substitute for post-filter ionized calcium to monitor the validity of regional citrate anticoagulation in continuous renal replacement therapy with less blood loss.