Efficacy and safety of calcium-containing replacement solution in continuous renal replacement therapy with regional citrate anticoagulation
Objective To compare the efficacy and safety of calcium-containing replacement solution versus calcium-free re-placement solution in continuous renal replacement therapy(CRRT)with regional citrate anticoagulation(RCA).Methods A total of 78 CRRT patients receiving RCA in the emergency intensive care unit(EICU)of the Affiliated Hospital of Xuzhou Medical Universi-ty were selected.According to the random number table method,they were divided into two groups:a calcium-containing replacement solution group(a calcium group,n=41)and a calcium-free replacement solution group(a calcium-free group,n=37).Both groups re-ceived post-dilution continuous veno-venous hemodiafiltration therapy.The calcium group used calcium-containing replacement solu-tion,while the calcium-free group used calcium-free replacement solution.The anticoagulation regimen and methods for calcium gluco-nate and potassium ion supplementation were the same in both groups.Both groups were compared for baseline data:age,gender ratio,etiology,Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ)score,Sequential Organ Failure Assessment(SOFA)score,and relevant laboratory indicators.The lifespan of hemofilters and reasons for their replacement were recorded.Serum calcium ion con-centrations and post-filter calcium ion concentrations were measured at post-CRTT 1,4,8,16,24,48 h,and 72 h.Both groups were compared for catheterization methods,transmembrane pressure before machine withdrawal,blood flow rate,replacement fluid flow rate,dialysate flow rate,treatment dose,filtration fraction,sodium citrate dosage,and calcium gluconate dosage.Their renal function recov-ery rate,the length of EICU stay,28-day mortality rate,and incidence of complications were also recorded.Results There were no statistical differences in baseline data between the two groups(all P＞0.05).The lifespan of hemofilters and reasons for their replace-ment did not differ significantly(all P＞0.05).The calcium group had a significantly lower dosage of calcium gluconate compared with the calcium-free group(P＜0.05).No statistical differences were found between the groups in catheterization methods,transmembrane pressure before machine withdrawal,blood flow rate,replacement fluid flow rate,dialysate flow rate,treatment dose,filtration fraction,and sodium citrate dosage(all P＞0.05).At post-CRRT 8 h and 24 h,the serum calcium ion concentrations were significantly higher in the calcium-free group than in the calcium group(both P＜0.05).No statistical differences in serum calcium ion concentrations were ob-served at post-CRRT 1,4,16,48 h,and 72 h(all P＞0.05).At post-CRRT 1,48 h,and 72 h,the post-filter calcium ion concentrations were significantly higher in the calcium group than the calcium-free group(all P＜0.05).No significant differences were found at post-CRRT 4,8,16 h,and 24 h(all P＞0.05).There were no statistical differences between the two groups in renal function recovery rate,the length of EICU stay,28-day mortality rate,or incidence of complications(all P＞0.05).Conclusions In RCA-based CRRT,the use of calcium-containing replacement solution and calcium-free replacement solution can exhibit similar efficacy and safety.Calcium-containing replacement solution significantly reduces the dosage of calcium gluconate,decreases the risks associated with manually preparing calcium-free replacement solution,and helps simplify clinical treatment procedures.
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