SUN-222 The efficacy of different citrate anticoagulant methods in hemodialysis with calcium-containing dialysate: a multicenter prospective observational cohort study

Abstract

The anticoagulation of hemodialysis is the precondition to ensure the success of hemodialysis (HD). In the case of active bleeding, Regional Citrate Anticoagulation(RCA) is the first choice for continuous renal replacement therapy. Conventional regional citrate anticoagulation combined with intravenous calcium supplementation in calcium-free dialysate has an ideal anticoagulant effect. However, the effect of calcium-containing dialysis is unknown. At present, there are various disunion treatment methods of RCA in calcium-containing dialysate. In order to explore the efficacy of different citrate anticoagulant methods, this multicenter cohort study systematically collected RCA protocols from different centers prospectively to compare the efficacy and safety of different RCA protocols in HD. REDCap software was utilized to establish the renal disease observation cohort database (REACH-CATCH). General training of anticoagulation nursing, coagulation degree assessment, blood gas analysis, data collection and database entry was carried out in each center to ensure the reliability of the data. At the same time, the identification code table was used to guarantee the privacy of patients, and the coagulation level was evaluated by researchers and relevant photos were uploaded (no patient identification information) to ensure the consistency of the evaluation. Finally, the team included 13 dialysis centers including Sichuan provincial people's hospital and Peking University Shenzhen hospital, among which 312 patients needed heparin-free dialysis due to the risk of bleeding. The completion rate, adverse reactions and anticoagulant status of different anticoagulant methods were observed. The use of citrate anticoagulant in each center can be divided into the following three types: method 1 (simplified: citric acid is pumped into the arterial end and calcium is not supplied into the venous end); method 2: (double-segment citric acid type: citric acid is pumped into the artery end and before the intravenous ampulla, and calcium is supplied to the vein end). method 3 (citric acid plus saline: artery end pump citric acid, slow drip normal saline before intravenous pot and calcium is not supplied into the venous end). A total of 234 dialysis times were completed with method 1, 67 times of dialysis were completed with the method 2 and 3 patients received method 3 and completed 11 times of dialysis. Rate of completing the preset dialysis time: method 1, 2 and 3 are 85.5%, 97.0% and 90.9% respectively p1,2<0.05，p2,3>0.05，p1,3>0.05). Clotting of grade 2 and below was regarded as effective for anticoagulation, and the anticoagulation effective rates of filters of method 1, method 2 and method 3 were 95.3%, 100% and 90.9%, respectively(P>0. 05). The anticoagulant effective rates of vein hub were 84.6%, 97.0% and 72.7% respectively (P<0. 05.) Regional citrate anticoagulation is relatively safe in general hemodialysis. Method 2 may be better in the completion of preset dialysis time and the anticoagulant effect of intravenous pot, but the number of cases is less than reported in the literature. This study will continue to expand the inclusion sample to compare the safety, effectiveness and simplicity of each citrate cohort.