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Application of regional citrate anticoagulation in membrane therapeutic plasma exchange

  • Nephrology - Original Paper
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Abstract

Background

Both regional citrate anticoagulation (RCA) and heparin are used as anticoagulants during membrane therapeutic plasma exchange (mTPE). However, there are few reports of comparisons of the two methods. The aim of this study was to compare different anticoagulants in mTPE and observe the effectiveness, safety, and advantages of RCA.

Methods

We retrospectively included 85 patients who underwent mTPE in the past 1 year, and divided them into three groups. Patients with no bleeding tendency were administered heparin anticoagulation; patients with bleeding tendency/with liver dysfunction/who had undergone an operation were treated with RCA, or did not receive anticoagulation. In the heparin group, low-dose heparin anticoagulation was administered; in the RCA group, 4% sodium citrate solution was administered, and 10% calcium gluconate solution was pumped from the venous circuit tube. The peripheral blood platelet count, prothrombin time (PT), activated partial thromboplastin time (APTT), and electrolytes were detected before and after treatment in all patients.

Results

A total of 255 sessions of mTPE were performed in 85 patients (2–7 times/case) with 120 sessions of heparin anticoagulation, 93 sessions of RCA, and 42 sessions of no anticoagulation. Compared with pretreatment values, the platelet count decreased by 53.7% and the PT and APTT increased (p < 0.05) in the heparin group after treatment. There were no differences in platelet count and PT before and after treatment in the RCA group. In the RCA group, the patients did not experience hypocalcemia or hypercalcemia, and no separator clotting occurred.

Conclusion

RCA is safe, feasible, and effective in mTPE, especially for patients with bleeding tendency and frequent monitoring is needed. It is worth widely developing and applying it in clinical practice.

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Acknowledgements

The study was supported by the National Natural Science Foundation of China (81770730) and the Grant 2017JJ2352 from Hunan Provincial Natural Science Fund.

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Authors and Affiliations

  1. Department of Nephrology, ESRD Center of the Second Xiangya Hospital, Central South University, Changsha, 410011, China

    Fang Yuan, Zheng Li, Xiejia Li & Hong Liu

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  1. Fang Yuan
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  2. Zheng Li
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  3. Xiejia Li
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  4. Hong Liu
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Correspondence to Hong Liu.

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The authors have no conflicts of interest to declare.

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The study protocol has been approved by the research institute’s committee on human research. The requirement of informed consent was waived by the review board (no. 2019011).

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Yuan, F., Li, Z., Li, X. et al. Application of regional citrate anticoagulation in membrane therapeutic plasma exchange. Int Urol Nephrol 52, 2379–2384 (2020). https://doi.org/10.1007/s11255-020-02581-0

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