The Relationship Between Different Dose Of Citrate And Post Filter Calcium Level In Continuous Blood Purification

Objectives:When use the regional citrate anticoagulation (RCA) in continuous veno-venous hemodiafiltration (CVVHDF) therapy, the relationship between different citra-te concentrations and post-filter ionized calcium (iCa); when the post-filter iCa in dif-ferent levels the safety and efficacy in the treatment.Methods:49 patients were admitted in EICU of the First Affiliated Hospital of Kun-ming Medical University from October 2014-January 2016 treated with CBP,23 pati-ents were male and 26 patients were female. The patients in our department under CVVHDF treatments who use the citrate as the anticoagulant were divided into post-filter iCa 0.1-0.2mmol/L (group A), post-filter iCa 0.2-0.3mmol/L (group B), post-filter iCa 0.3-0.4mmol/L (group C), every group has 24 cases. The vascular accesses of which used doulble limen venous catheter inserted through femoral veins. The multiFiltrate Ci-Ca hemodiafiltration apparatus and AV1000 filter (Membrane area of 1.8m2) were applied into CVVHDF, with the post displacement, flow rate of 1000-2000ml/h, dialysate flow rate of 2000-3600 ml/h, and blood flow rate of 100-150 ml/min, dialysate flow rateto blood flow rate was 20:1. Filters and catheters were prerinsed with 0.9% sodium chloride 500ml containing 12500 units of heparin sodium and 3000 ml physiological salind before the start of CVVHDF. Three groups of citrate dose start from 4mmol/L, the dose of citrate was adjusted according to the post-filter ionized calcium, the dose of calcium gluconate was start from 1.7 mmol/L, the dose of calcium gluconate was adjusted according to the systemic ionized calcium, and the level of systemic ionized calcium was maintained 1.12-1.2mmol/L. The average hourly citrate concentration, citrate dose, filter life and filter cloting was recorded to access the efficacy of the citrate anticoagulation; when the treatment start 30 mins, monitoring the pre and post filter blood gas analyzers (PH,HCO3-,K+,Na+,Ca2+), monitor every six hours later, until the end of the treatment, monitor the total calcium levels every 12h, and calculate the total to ionized calcium ratio to evaluate the safety of the citrate anticoagulation. The change of blood routine, liver and kidney function-s,blood coagulation before and after CVVHDF were monitored, the tendency of bleeding and active bleeding.To evaluate the influence of citrate anticoagulation to the blood coagulation and the efficacy of the CBP.Results:There were 24 cases in each group. There were no statistically significant difference in sexes, ages, weights, APACHE II scores of the three groups before the treatment (P>0.05); there was no statistically significant difference in primary diseases (P>0.05); there were no statistically significant difference in blood routine, liver and kidney functions, blood coagulation, electrolyte and acid-base balance before CVVHDF of the three groups (P>0.05).1. Three groups of the filter life were 49.48±14.19h,49.52±15.75 and 30.39±11.63 h, thefilter life of group A and B were much longer than group C (P<0.05), there was no difference between group A and B of the filter life (P>0.05); the filter clotting has obvious difference (P<0.05), and drawing the Kaplan-Meier survival curve, the filter survival rate in group A was 69.8%, the group B was 70.8%, the group C was 23.4%, the survival rate in group C was shorter than group A and B, there was statistically significant difference (P<0.05).2.The relationship between citrate concentration in three groups and post-filter calciu-m has high negative correlation (r=-0.765), the average hourly concentration and am-ount of citrate have obvious differences, group A>group B>group C (P<0.05).3.The blood gas analysis of acid-base balance disorders and hypocalcemia situation is different in three groups in the 30min,6h,12h, the group A was more likely to appear acid-base disturbance and hypocalcemia than group B and C (P<0.05), there was no difference between group B and group C (P>0.05), the rest of the electrolyte results has no significant statistical difference (P>0.05). There was no statistically significa-nt difference of the blood gas analysis before and after the treatment in three groups (P>0.05).4.There were difference in the total to ionized calcium ratio percentage in three groups in the treatment of 12h,24h,48h,72h (P<0.05), there were difference between the group A and group B, C (P<0.05), there was no difference between group B and group C (P>0.05).5.After therapy the Cr and BUN levels were significantly lower than those before therapy in three groups (P<0.05), there was obvious difference before and after the treatment (P<0.05), and the clearance of Cr, group B> group A> group C, but th-ere was no statistically significant difference (P> 0.05). There was no significant change of APTT and PT before and after the treatment in three groups (P> 0.05). There was no obvious change before and after treatment in group A and B of Hb and PLT (P>0.05), after therapy the Hb level was lower than that before therapy in group C (P<0.05).Conclusions:1. When the post-filter calcium sustained 0.2-0.3mmol/L, the efficacy and safety of the anticoagulation is much better.2. There was obvious negative correlation between citrate concentration and post-filt-er calcium,the higher of the post-filter calcium concentration, the less efficacy of the anticoagulation; the lower of the post-filter calcium concentration, the less safer of the anticoagulation.