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Objective To compare the anticoagulation effect of regional citrate and heparin in patients with sustained low-efficiency hemodialysis (SLED).Method This study was conducted in the teaching hospital of Sichuan University between November 2011 and January 2013.Sixty-three patients suffering from acute kidney injury or end-stage renal diseases (ESRD) were enrolled and further randomized to 2 groups:citrate and heparin anticoagulation treatment groups in SLED.SLED was conducted by Fresenius 4008sARrTplus dialyzer for 8 hours each session,and blood flow was set at 150 ml/min.Prothrombin time (PT),activated partial thromboplastin time (APTT) and platelet (PLT) count were analyzed.Result Sixty-three patients underwent 118 sessions of SLED.Among them,59 patients (93.7％) was discharged after treatment or converted to outpatient intermittent hemodialysis,and 4 patients died of multiple organ failure during hospitalization.Compared with that in the citrate group,both PT and APTT in heparin group was significantly higher [PT:(15.5 ± 2.0) s vs (12.3 ± 2.7) s,P ＜ 0.001 ; APTF:(56.0 ± 10.9) s vs (32.8 ± 6.1) s,P ＜ 0.001 ; respectively] at 2 h during SLED.However,the PT and APTT levels in heparin group decreased afterwards and were similar with those in the citrate groups at 5 h during treatment.There is no difference on PLT counts between these two groups after treatment.Conclusion The anticoagulation effect of regional citrate and heparin was similar in patients when receiving SLED.Regional citrate may be an alternative anticoagulant approach for the patients at high risk of bleeding who require the treatment of SLED.
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ObjectiveTo compare the therapeutic effec between sustained low-efficiency dialysis (SLED) and continuous blood purification (CBP) in critically ill patients.MethodsAccording to the treatment ways,96 critically ill patients were divided into SLED group and CBP group.A comparison was made on the biochemical indicators,in-hospital duration,hemodynamic parameters,acute physiology and chronic health evaluation (APACHE-Ⅱ ),the survival and the mortality rates.ResultsAfter treatment,the levels of serum creatine kinase isozyme MB (CK-MB),creatine kinase (CK),creatinine (Cr),glutamic-oxalacetic transaminase (AST),glutamate-pyruvate transaminase (ALT),APACHE Ⅱ score on the 1st,2nd and 7th day were lower than those prior to the treatment in both groups ( P ＜0.05).There were no statistical differences in in-hospital duration, biochemical indicators, APACHEⅡscore,hemodynamic parameters,the survival rate and the mortality rate between the two groups (P ＞ 0.05 ).ConclusionsSLED has similar hemodynamic stability with CBP,and the two methods have similar treatment effects in critically ill patients.However,SLED can be relatively economical and convenient for critically ill patients in clinical.