ABSTRACT
Objective To explore the advantages and disadvantages of regional citrate anticoagulation (RCA) mode by comparing to non-anticoagulation mode for continuous renal replacement therapy (CRRT)in patients with acute kidney injury (AKI) at high risk of bleeding.Methods The criterion for inclusion of patients was stage 3 of AKI selected according to Kidney Disease Improving Global Outcomes guideline.And those patients had high risk factors of bleeding as well as such as post-major opertion,coagulopathy (prothrombin time or activated partial thromboplastin time ＞ 1.5 times the normal control,or prothrombin time ＞ 18 s,activated partial thromboplastin time ＞ 60 s),thrombocytopenia (＜ 50 × 109/L),and combined therapy with anticoagulant,antiplatelet or thrombolytic drugs.The CRRT was initiated within 4 h after randomization.The exclusion criteria was severe liver failure (serum total bilirubin ＞ 171 μmmol/L).Continuous venovenous hemodiafiltration mode was employed in both groups,and the filter was changed routinely every 72 h,unless clotting developed in the extracorporeal circuit.Because the commercial calcium-free dialysate was not available in the market,this dialysate was prepared by the intensive care unit (ICU) nurses.Results Thirty two patients were equally divided in those two groups,and most of them were admitted to ICU after major surgery.There were no significant differences between the groups in data of blood gas analysis,hepatic/renal/coagulative functions,electrolyte,hemoglobin and platelet count before or after CRRT.The filter was more durable in RCA mode than that in non-RCA mode determined through Kaplan-Meier curve analysis (x2 =9.707,P =0.002),with the mean time (h) 36.01 (26.61-45.42)vs.22.04 (18.35-25.73).More packed red blood cells and platelet were required in non-RCA mode than those in RCA mode during CRRT.There was no significant difference in ICU mortality between RCA mode and non-RCA mode with 7/16 vs.9/16,P =0.724.Severe blood loss and malignant arrhythmia events did not occur in both modes.The body temperature,systemic electrolyte,post-filter ionized calcium levels and the ratio of total to ionized systemic calcium were basically preserved at a target range in RCA group during CRRT.Conclusions RCA-CRRT is a safe and effective mode for AKI patient with high risk of bleeding,which can extend the durability of filter,and lower the risk of blood loss.However,the study failed to show a mortality benefit with the RCA mode,and it could also increase the workload of nurses under the current domestic setting.
ABSTRACT
Objective To explore the advantages and disadvantages of regional citrate anticoagulation (RCA) mode by comparing to non-anticoagulation mode for continuous renal replacement therapy (CRRT)in patients with acute kidney injury (AKI) at high risk of bleeding.Methods The criterion for inclusion of patients was stage 3 of AKI selected according to Kidney Disease Improving Global Outcomes guideline.And those patients had high risk factors of bleeding as well as such as post-major opertion,coagulopathy (prothrombin time or activated partial thromboplastin time ＞ 1.5 times the normal control,or prothrombin time ＞ 18 s,activated partial thromboplastin time ＞ 60 s),thrombocytopenia (＜ 50 × 109/L),and combined therapy with anticoagulant,antiplatelet or thrombolytic drugs.The CRRT was initiated within 4 h after randomization.The exclusion criteria was severe liver failure (serum total bilirubin ＞ 171 μmmol/L).Continuous venovenous hemodiafiltration mode was employed in both groups,and the filter was changed routinely every 72 h,unless clotting developed in the extracorporeal circuit.Because the commercial calcium-free dialysate was not available in the market,this dialysate was prepared by the intensive care unit (ICU) nurses.Results Thirty two patients were equally divided in those two groups,and most of them were admitted to ICU after major surgery.There were no significant differences between the groups in data of blood gas analysis,hepatic/renal/coagulative functions,electrolyte,hemoglobin and platelet count before or after CRRT.The filter was more durable in RCA mode than that in non-RCA mode determined through Kaplan-Meier curve analysis (x2 =9.707,P =0.002),with the mean time (h) 36.01 (26.61-45.42)vs.22.04 (18.35-25.73).More packed red blood cells and platelet were required in non-RCA mode than those in RCA mode during CRRT.There was no significant difference in ICU mortality between RCA mode and non-RCA mode with 7/16 vs.9/16,P =0.724.Severe blood loss and malignant arrhythmia events did not occur in both modes.The body temperature,systemic electrolyte,post-filter ionized calcium levels and the ratio of total to ionized systemic calcium were basically preserved at a target range in RCA group during CRRT.Conclusions RCA-CRRT is a safe and effective mode for AKI patient with high risk of bleeding,which can extend the durability of filter,and lower the risk of blood loss.However,the study failed to show a mortality benefit with the RCA mode,and it could also increase the workload of nurses under the current domestic setting.
ABSTRACT
Objective To investigate apoptosis of polymorphonuclear neutrophil and activity of caspase-3 in the peripheral blood and discuss their correlation with development of multiple organ dysfunc- tion syndrome (MODS) after multiple injury. Methods A total of 55 patients with multiple injury were included in the prospective study, and divided into two groups, ie, MODS group (multiple injury patients who developed MODS,) and non-MODS group (multiple injury patients who were free from MODS). The activity of caspase-3 was detected by flow cytometry and the serum levels of IL-6 and IL-10 were detected by ELISA. Then, we evaluated whether the neutrophil apoptesis was correlated with the ser- um levels of IL-6 and IL-10 in patients with MODS. Results Compared with non-MODS group, neu- trophil apoptesis was significantly reduced and activated caspase-3 decreased significantly in MODS group (P <0.05). In MODS group, serum IL-6 was increased significantly while serum IL-10 was decreased significantly compared with non-MODS group. The apoptosis of neutrophil in multiple injury patients with MODS had a negative correlation with IL-6 levels but a positive correlation with IL-10 levels. Conclu- sions The delayed apoptosis of neutrophil due to decreased activated caspase-3 may play partial roles in the development of MODS after multiple injury. IL-6 and IL-10 may contribute to the apoptotic changes.