[The safety and efficacy of regional citrate anticoagulation in sustained low efficiency dialysis].

OBJECTIVE: To evaluate the safety and efficacy of regional citrate anticoagulation in sustained low efficiency dialysis (SLED). METHODS: A total of 45 patients with acute kidney injury (AKI) or end stage renal disease (ESRD) admitted in our hospital from August 2011 to September 2012 were prospectively enrolled in this study. All the patients received SLED treatment by Fresenius 4008sARrTplus dialyzer through either femoral or internal jugular venous catheter, with each session of SLED treatment lasting for 8 hours. All the patients were pumped in 4% tri-sodium citrate solution through the arterial line at 130 ml/hour and 10% calcium gluconate through the venous line at 40 ml/hour. The blood flow was 150 ml/minute while the calcium-free dialysate was delivered at 200 ml/minute. Systemic citrate concentration, peripheral and post dialyzer ionized calcium levels at 0, 2 and 5 hour were recorded. RESULTS: All the 45 patients underwent 162 sessions of SLED with 2 were discontinued due to III° dialyzer coagulation, and other 160 SLED sessions (98.8%) were all successfully performed. The systemic citrate concentration at 0 hour was (0.14 ± 0.06) mmol/L, the systemic citrate concentrations at 2 and 5 hour were slightly increased while no statistical difference was found[(1.08 ± 0.12) mmol/L vs (1.11 ± 0.17) mmol/L, P > 0.05]. The 0, 2, 5 hour peripheral blood ionized calcium levels were (1.04 ± 0.13) mmol/L, (1.07 ± 0.23) mmol/L and (1.04 ± 0.24) mmol/L, respectively, with no significant difference (P > 0.05). The post dialyzer ionized calcium levels were (0.31 ± 0.04) mmol/L at 2 hour and (0.29 ± 0.03) mmol/L at 5 hour. The transmembrane pressure at 2 hour was (104.5 ± 17.8) mm Hg(1 mm Hg = 0.133 kPa), and (109.3 ± 20.1) mm Hg at 5 hour, however the increase was not of statistical significance (P > 0.05). At 5 hour, prothrombin time and activated partial thrombin time were identified to be similar to those before SLED. During the treatments, no bleeding complication, thrombocytopenia, cardiac arrhythmia, hypernatremia, metabolic alkalosis or hypotension was observed. CONCLUSION: SLED under regional citrate anticoagulation is safe and effective. Citrate achieves satisfying regional anticoagulation effect without interfering systemic clotting function, thus this study provides a new option of SLED anticoagulation for clinicians.

[Sustained low efficiency dialysis on patients with multiple organ failure resulted from diabetic kidney disease].

OBJECTIVE: To investigate the effect of sustained low efficiency dialysis (SLED) on patients with multiple organ failure resulted from diabetic kidney disease (DKD). METHODS: Five DKD patients who developed MOF between Nov. 2011 and Jan. 2012 were recruited for SLED treatment (dose: 200 ml/min, for 8 to 12 hours every other day) in the West China Hospital. Meanwhile, other therapeutic measures, such as underlying disease management, infection control and nutritional support were applied. Biochemical changes and progress of disease were observed. RESULTS: One patient died unexpectedly 12h after admission to hospital. The main cause of death was multiple organ failure. The other four patients had sharp improvements in high potassium concentration and (or) metabolic acidosis after SLED therapy, with obvious amelioration of main organs functions and oxygenation index [PO2 (103.3 +/- 25.7) mm Hg]. Two ventilator dependent patients successfully weaned from mechanical ventilation 3 to 5 days after the treatment. BNP of the patients decreased from > 35,000 ng/mL before the treatment to (13,312 +/- 3,537) pg/mL after the treatment (P < 0.05). APACHE II decreased by 10.3%, 41.9% and 67.8% within 24 hours, three days and five days respectively. CONCLUSION: SLED as early intervention can bring significant benefits to DKD patients with multiple organ failure (MOF). SLED has the same efficacy as continuous renal replacement therapy (CRRT) in the treatment of MOF for patients with DKD.