Effect of sodium citrate anticoagulation in Hemodiafiltration

Objective To investigate the efficacy and safety of sodium citrate pumping in both side of arteriovenous end in Hemodiafiltration.Methods From July 2017 to June 2018,60 patients,came from blood purification center of nephrology department in Zhongnan hospital of Wuhan university,who had active bleeding or bleeding tendency,were selected to the research object.Using the local anticoagulation,4% sodium citrate in vitro in arteriovenous end pumping,respectively,at the same time adjust the dialysate ion concentration,close monitoring of blood gas analysis,records of the patient's vital signs,extracorporeal circulation line and dialyser coagulation conditions.Results 1、60 patients with 114 HDF about 4 hours treatment are completely finished,including blood coagulation withⅠmagnitude about 8 cases of,grade Ⅱcoagulation occurred in 2 cases;2,the pH value,PCO2,HCO₃^-,BE,Na₊ and peripheral free calcium in the blood were tested before treatment,2 hours after treatment and at the end of treatment,the value were all increased compared with the first time,but still in the normal range,the difference was statistically significant (P<0.05).3,the patient's vital signs were stable during the treatment,no patient had clinical symptoms such as mouth,face,fingertip numbness and hand twitch.4,none of the 60 patients with 114 times of treatment showed increased and new bleeding events caused by sodium citrate anticoagulation.Conclusion Regional citrate anticoagulation in both arteriovenous end and supplemented by the method of regulating the ion concentration of dialysate,can safely and effectively satisfied with the patients with bleeding or bleeding tendency for the treatment of HDF.It is necessary to closely monitor the changes of blood gas analysis and adjust the ion concentration of dialysate according to the changes of blood gas analysis.