Application of anti-coagulation of citric acid in continuous renal replacement therapy for patients with lactic acidosis

Objective To study the effectiveness and safety of local citrate anticoagulation (RCA) and low molecular weight heparin anticoagulation in continuous renal replacement therapy (CRRT) for patients with lactic acidosis.Methods A total of 55 patients with lactic acidosis who were treated with CRRT in our hospital from 2015.05 to 2018.07 were enrolled,including 42 patients in the RCA group (observation group) and 13 patients in the low molecular weight heparin group (control group).The changes of platelet (PLT),activated partial thromboplastin time (APTT),serum calcium (Ca²⁺),pH values,serum lactic acid (Lac),bicarbonate ion (HCO₃^-),base excess (BE),sodium ion (iNa⁺) and calcium ion (iCa²⁺) before and after CRRT were compared between the two groups.Comparison of filter service life and coagulation incidence between the two groups was also performed.Results At 8h after treatment,the decrease of Lac in the observation group was significantly greater than that in the control group (P<0.05).The APTT after treatment in the control group was prolonged compared with that before treatment,and the PLT value was significantly lower than that in the observation group with statistical significance of difference (P<0.05).The difference of other indices between the two groups were not statistically significant (P>0.05).The coagulation rate of in vitro circulation in the observation group was significantly lower than that in the low-heparin group,and the filter life was significantly longer than that in the control group with statistical significance of difference (P<0.05).Conclusions This study indicates that citrate anticoagulation can play a role in acid-base buffering in patients with lactic acidosis,reduce the level of lactic acid significantly,mitigate bleeding risk and prolong the filter life.