Application of sodium citrate in continuous renal replacement therapy

Abstract

Objective To discuss the anticoagulation effects and safety of sodium citrate in continuous renal replacement therapy (CRRT) . Methods A total of 140 cases who underwent CRRT in the intensive care unit (ICU) of Zhejiang Provincial People′s Hospital from January 2014 to December 2016 were selected as research objects and divided into the heparin sodium group (n=56) , the low molecular weight heparin calcium group (n=48) and the sodium citrate group (n=36) according to the anticoagulation methods. The differences of anticoagulation effects, the average service life of the pipelines, the overall pipeline quantity, the total cost of blood purification, the blood transfusion amount during CRRT, total bilirubin (Tbil) , serum creatinine (Cer) , Na+, K+, prothrombin time (PT) , activated partial prothrombin time (APTT) , platelet count (PLT) before and after CRRT and the complications related to CRRT among the three groups were compared. Results The anticoagulation effect of the sodium citrate group was obviously better than that of the other two groups (χ2=18.809, P<0.05) . The average service life of the pipelines of the sodium citrate group was (29.3±5.4) h, which was obviously higher than that of the heparin sodium group (16.5±3.5) h and the low molecular weight heparin calcium group (24.8±4.1) h, and the intergroup difference was statistically significant (F=6.596, P<0.05) . The transfusion amount of red blood cells, plasma and platelets of the sodium citrate group was (12.3±2.8) U, (1 875.5±198.6) ml and (23.5±8.6) U, which was obviously lower than that of the heparin sodium group [ (16.5±5.6) U, (2 463.4±265.4) ml and (58.3±18.5) U] and the low molecular weight heparin calcium group [ (13.4±3.2) U, (1 954.4±214.5) ml and (32.6±11.5) U], and the intergroup differences were all statistically significant (F=4.563, 3.896, 7.456; P<0.05) . The Tbil, Cer, Na+ and K+ of all groups decreased after CRRT, and the differences were all statistically significant (P<0.05) . There were statistical significance in PT, APTT and PLT among the three groups (F=4.562, 4.153, 5.468; P<0.05) . The PLT of the sodium citrate group increased significantly after CRRT, with statistical difference (P<0.05) . The incidence rate of hemorrhages in skin, digestive tract, puncture point and trachea of the sodium citrate group was respectively 2.8%, 5.6%, 2.8% and 5.6%, which was obviously lower than that of the heparin sodium group (23.2%, 12.5%, 16.1%, 12.5%) and the low molecular weight heparin calcium group (6.3%, 10.4%, 8.3%, 8.3%) , and the differences were all statistically significant (χ2=6.678, 7.553, 6.849, 7.534; P<0.05) . The incidence rate of heparin induced thrombocytopenia (HIT) of the heparin sodium group was 8.9% (5/56) . Conclusions The anticoagulation effect of sodium citrate in CRRT is remarkable with less complications. It can significantly reduce the amount of blood transfusion and the cost of blood purification and is worth of promotion in clinical application. Key words: Continuous renal replacement therapy; Sodium citrate; Anticoagulation effect; Complications