Clinical efficacy and individualized scheme of segmented citrate anticoagulation in dialysis of patients with high risk of bleeding

Objective To compare the safety and effectiveness of anticoagulation strategies between segmented citrate anticoagulation (SCA) and non-heparin anticoagulation (NA), and investigate the individualized scheme of SCA. Methods Sixty patients who met our inclusion criteria and underwent dialysis due to acute and chronic renal failure in our department from October 2019 to December 2020 were recruited in this study, and were randomly divided into SCA group and NA group. Blood gas, electrolyte and activated clotting time (ACT) were monitored during dialysis. The coagulation grade of the filter and hemorrhagic condition were recorded after dialysis. The coagulation indexes before and after dialysis were compared, and the kt/v value and total ultrafiltration volume were calculated. The fluctuation of calcium ion and ACT value among SCA subgroups were further compared. Plasma sodium citrate and calcium clearance were analyzed by regression analysis. Results The percentage of effective anticoagulation (96.7% vs 63.3%), kt/v value (1.21±0.24 vs 0.89±0.32) and total ultrafiltration volume (2 033.16±708.34 vs 1 584.43±868.88 mL) were significantly higher in the SCA group than the NA group (P < 0.05). The ACT value was shortened in the NA group, but no such change was seen in the SCA group. In some SCA patients with high hematocrit (0.32±0.07 vs 0.23±0.04, P < 0.05), their ACT value was prolonged to the ideal multiple. There was a significant linear relationship between plasma sodium citrate flow rate and calcium clearance rate (F=14.671, P < 0.05). Conclusion SCA is superior to NA in anticoagulant efficacy, dialysis adequacy and prevention of microthrombosis. An ideal anticoagulant regimen can be realized in part of patients