Background: A simplified protocol for regional citrate anticoagulation (RCA) using a commercial calcium-containing replacement solution, without continuous calcium infusion, is more efficient for use in continuous ren...Background: A simplified protocol for regional citrate anticoagulation (RCA) using a commercial calcium-containing replacement solution, without continuous calcium infusion, is more efficient for use in continuous renal replacement therapy (CRRT). We aim to design a randomized clinical trial to compare the safety and efficacy between calcium-free and calcium-containing replacement solutions in CRRT with RCA.Methods: Of the 64 patients receiving RCA-based postdilution continuous venovenous hemodiafiltration (CVVHDF) enrolled from 2017 to 2019 in West China Hospital of Sichuan University, 35 patients were randomized to the calcium-containing group and 29 to the calcium-free replacement solution group. The primary endpoint was circuit lifespan and Kaplan-Meier survival analysis was performed. Secondary endpoints included hospital mortality, kidney function recovery rate, and complications. The amount of 4% trisodium citrate solution infusion was recorded. Serum and effluent total (tCa) and ionized (iCa) calcium concentrations were measured during CVVHDF.Results: A total of 149 circuits (82 in the calcium-containing group and 67 in the calcium-free group) and 7609 circuit hours (4335 hvs. 3274 h) were included. The mean circuit lifespan was 58.1 h (95% CI 53.8-62.4 h) in the calcium-containing groupvs. 55.3 h (95% CI 49.7-60.9 h, log rankP = 0.89) in the calcium-free group. The serum tCa and iCa concentrations were slightly lower in the calcium-containing group during CRRT, whereas the postfilter iCa concentration was lower in the calcium-free group. Moreover, the mean amounts of 4% trisodium citrate solution infusion were not significantly different between the groups (171.1 ± 15.9 mL/hvs. 169.0 ± 15.1 mL/h,P = 0.49). The mortality (14/35 [40%]vs. 13/29 [45%],P = 0.70) and kidney function recovery rates of AKI patients (19/26, 73%vs. 14/24, 58%,P = 0.27) were comparable between the calcium-containing and calcium-free group during hospitalization, respectively. Six (three in each group) patients showed signs of cit展开更多
本文以Tcu220c-IUD为对照,测定置MA-IUD妇女月经总量;经血纤溶系统包括组织型纤溶酶原激活剂(t-PA)活性、纤溶酶原(PLG)含量和纤溶活性(Fa);经血抗凝血物质包括抗凝血酶-Ⅲ(AT-Ⅲ)活性、蛋白 C(PC)抗原含量和 PC 活性以及经血凝血因子...本文以Tcu220c-IUD为对照,测定置MA-IUD妇女月经总量;经血纤溶系统包括组织型纤溶酶原激活剂(t-PA)活性、纤溶酶原(PLG)含量和纤溶活性(Fa);经血抗凝血物质包括抗凝血酶-Ⅲ(AT-Ⅲ)活性、蛋白 C(PC)抗原含量和 PC 活性以及经血凝血因子包括因子Ⅶ相关抗原(ⅧR:Ag)和纤维蛋白原(Fg)含量。实验表明 MA-IUD 能使妇女月经量明显减少,其与宫腔局部纤溶活性和抗凝血系统活性下降有关。宫腔局部凝血因子无明显改变,IUD 之孕激素的局部释放对肝脏无影响。展开更多
基金1·3·5 project for disciplines of excellence-Clinical Research Incubation Project, West China Hospital, Sichuan University(18HXFH018)
文摘Background: A simplified protocol for regional citrate anticoagulation (RCA) using a commercial calcium-containing replacement solution, without continuous calcium infusion, is more efficient for use in continuous renal replacement therapy (CRRT). We aim to design a randomized clinical trial to compare the safety and efficacy between calcium-free and calcium-containing replacement solutions in CRRT with RCA.Methods: Of the 64 patients receiving RCA-based postdilution continuous venovenous hemodiafiltration (CVVHDF) enrolled from 2017 to 2019 in West China Hospital of Sichuan University, 35 patients were randomized to the calcium-containing group and 29 to the calcium-free replacement solution group. The primary endpoint was circuit lifespan and Kaplan-Meier survival analysis was performed. Secondary endpoints included hospital mortality, kidney function recovery rate, and complications. The amount of 4% trisodium citrate solution infusion was recorded. Serum and effluent total (tCa) and ionized (iCa) calcium concentrations were measured during CVVHDF.Results: A total of 149 circuits (82 in the calcium-containing group and 67 in the calcium-free group) and 7609 circuit hours (4335 hvs. 3274 h) were included. The mean circuit lifespan was 58.1 h (95% CI 53.8-62.4 h) in the calcium-containing groupvs. 55.3 h (95% CI 49.7-60.9 h, log rankP = 0.89) in the calcium-free group. The serum tCa and iCa concentrations were slightly lower in the calcium-containing group during CRRT, whereas the postfilter iCa concentration was lower in the calcium-free group. Moreover, the mean amounts of 4% trisodium citrate solution infusion were not significantly different between the groups (171.1 ± 15.9 mL/hvs. 169.0 ± 15.1 mL/h,P = 0.49). The mortality (14/35 [40%]vs. 13/29 [45%],P = 0.70) and kidney function recovery rates of AKI patients (19/26, 73%vs. 14/24, 58%,P = 0.27) were comparable between the calcium-containing and calcium-free group during hospitalization, respectively. Six (three in each group) patients showed signs of cit
