BACKGROUND Flexitrate, an innovative regional citrate anticoagulation (RCA) protocol, was compared to traditional RCA (tRCA) and Heparin anticoagulation protocols in intensive care patients treated with continuous renal replacement therapy (CRRT). METHODS A single-center, retrospective, cohort study, was done in a 26-bed intensive care unit in a large community hospital. Eighty dialysis sessions (Flexitrate = 2852 h, tRCA = 3580 h and Heparin = 2026 h), performed in 53 patients, were evaluated for filter life, RCA control, and metabolic control. RESULTS In the Flexitrate cohort, 3.8% of filters clotted, compared to 16.9% with tRCA and 28.3% with Heparin (p < 0.001 for Flexitrate compared to either tRCA or Heparin). Filter survival was significantly improved with Flexitrate compared to tRCA (HR 0.24, p = 0.018) or Heparin (HR 0.14, p = 0.004). Anticoagulation control was superior with Flexitrate with Patient Ionized Calcium out of target a median of 16% of the time, compared to 27% for tRCA (p < 0.001). Filter Ionized Calcium was out of target a median of 6.8% of the time, compared to 23% for tRCA (p = 0.03). Flexitrate produced significantly less alkalosis, hypernatremia, and hypocalcemia than tRCA, and overall metabolic control was comparable to Heparin anticoagulation. The only adverse metabolic outcome with Flexitrate was increased hypomagnesemia. CONCLUSIONS The Flexitrate protocol extended filter life, delivered more consistent anticoagulation, and provided superior metabolic control compared to a tRCA protocol. Filter life was superior to Heparin anticoagulation, with similar metabolic control. A randomized control trial comparing these protocols is recommended.

中文翻译：

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在连续静脉血液透析滤过中加重局部柠檬酸抗凝作用：一项回顾性分析。

背景技术Flexitrate是一种创新的区域柠檬酸盐抗凝（RCA）方案，在接受连续肾脏替代疗法（CRRT）治疗的重症监护患者中与传统RCA（tRCA）和肝素抗凝方案进行了比较。方法在大型社区医院的26张病床的重症监护病房中进行一项单中心，回顾性队列研究。对53例患者进行了80次透析（Flexitrate = 2852 h，tRCA = 3580 h和肝素= 2026 h），以评估滤膜寿命，RCA控制和代谢控制。结果在Flexitrate队列中，有3.8％的过滤器凝结，而tRCA为16.9％，肝素为28.3％（与tRCA或肝素相比，Flexitrate的p <0.001）。与tRCA（HR 0.24，p = 0.018）或肝素（HR 0.14，p = 0.004）相比，Flexitrate过滤器的存活率显着提高。Flexitrate的患者电离钙的抗凝控制优于靶标，平均时间为16％，而tRCA的抗凝控制为27％（p <0.001）。过滤器电离钙的中位数时间为目标的6.8％，而tRCA的中值时间为23％（p = 0.03）。与tRCA相比，Flexitrate产生的碱中毒，高钠血症和低钙血症明显减少，并且总体代谢控制与肝素抗凝治疗相当。Flexitrate唯一不利的代谢结果是低镁血症增加。结论与tRCA方案相比，Flexitrate方案可延长过滤器寿命，提供更一致的抗凝作用，并提供出色的代谢控制。过滤器寿命优于肝素抗凝剂，并具有相似的代谢控制。建议比较这些方案的随机对照试验。