Regional Citrate Anticoagulation versus No-Anticoagulation for Continuous Venovenous Hemofiltration in Acute Severe Hypernatremia Patients with Increased Bleeding Risk: A Retrospective Cohort Study.

Abstract

PURPOSE:

This study was aimed at evaluating the efficacy and safety of regional citrate anticoagulation (RCA) versus no-anticoagulation continuous venovenous hemofiltration (CVVH) in acute severe hypernatremia patients with increased bleeding risk.

MATERIALS AND METHODS:

Acute severe hypernatremia patients with high bleeding risk who underwent CVVH in our center between January 2011 and October 2017 were considered as candidates. Patients who were <18 years old, with hypovolemic hypernatremia, and had systemic anticoagulation were excluded. The included patients were divided into RCA and no-anticoagulation groups according to their anticoagulation strategy during CVVH and matched by age, sequential organ failure assessment scores, and vasopressor dependency.

RESULTS:

Of the 64 included patients, no-anticoagulation and RCA were employed for CVVH in 23 and 41 patients, respectively. The serum sodium reduction rate (RRSeNa) was not significantly different between the no-anticoagulation and RCA groups (p = 0.729). Compared to no-anticoagulation, RCA significantly prolonged the circuit survival time (15 h [4.1-23.9] vs. 51 h [21.3-80.7], p = 0.001). The incidence of filter failure was 65.2% (15/23) in the no-anticoagulation group and 2.4% (1/41) in the RCA group (p < 0.001), respectively. In the matched cohort, the RRSeNas were not different between the 2 groups (p = 0.569), and the filter lifespan was significantly longer in the RCA group as well (p < 0.001).

CONCLUSION:

RCA might be safe and effective for acute severe hypernatremia patients who underwent CVVH treatment. Further prospective, randomized, control trials are warranted to obtain robust evidences.

• Authors: Lijuan Zhao, Feng Ma, Yan Yu, Yangping Li, Yan Wang, Lijie He, Meilan Zhou, Xiujuan Tian, Rui Jing, Li Li, Lu Li, Chen Huang, Ming Bai, Shiren Sun
• Journal: Blood purification (Blood Purif) Vol. 49 Issue 1-2 Pg. 44-54 ( 2020) ISSN: 1421-9735 [Electronic] Switzerland
• PMID: 31522180 (Publication Type: Clinical Trial, Comparative Study, Journal Article)
• Copyright: © 2019 S. Karger AG, Basel.

Chemical References

• Anticoagulants
• Citric Acid

Topics

• Acute Disease
• Adult
• Aged
• Anticoagulants (administration & dosage)
• Citric Acid (administration & dosage)
• Female
• Hemodiafiltration
• Hemorrhage (blood, etiology, prevention & control)
• Humans
• Hypernatremia (blood, therapy)
• Male
• Middle Aged
• Retrospective Studies
• Risk Factors
• Severity of Illness Index