Comparisons of anticoagulatory and therapeutic effects of low-molecular-weight heparin sodium versus sodium citrate in patients with severe acute kidney injury on continuous renal replacement therapy

Objective To explore the effects of sodium citrate anticoagulation on inflammatory state in patients with severe acute renal injury(AKI)on continuous renal replacement therapy(CRRT).Methods From January 2018 to December 2019,50 AKI patients on CRRT in intensive care unit(ICU)were randomly assigned into two groups of sodium citrate(with bleeding tendency or surgical perioperative period)and low-molecular-weight heparin(without bleeding tendency).The levels of tumor necrosis factor(TNF-a),interleukin-6(IL-6),procalcitonin(PCT),C-reactive protein(CRP),white blood cell count(WBC),neutrophil to lymphocyte ratio(NLR),activated partial thromboplastin time(APTT),prothrombin time(PT),thrombin time(TT),serum total calcium,serum magnesium,blood phosphorus and clinical curative effect were compared between two groups before and after treatment.Results A total of 100 cases/207 times were recruited,including 50 cases/103 times in sodium citrate group and 50 cases/104 times in low-molecular-weight heparin group.After treatment,the declines of TNF-a,IL-6 and PCT was significantly greater in sodium citrate group than those in low-molecular-weight heparin group.And the differences were statistically significant(P<0.05).The longer treatment duration,the greater reduction.When dialysis duration was >24 h,the decline in NLR was significantly higher in regional citrate group than that in low-molecular-weight heparin group.And the difference was statistically significant(P<0.05);Further subgroup analysis was carried out for these patients with AKI patients complicated by severe infection.Compared with low-molecular-weight heparin group,the levels of TNF-a,IL-6 and PCT decreased markedly in sodium citrate group at 6/12/24 h post-dialysis.The longer treatment duration,the greater reduction.And the difference was statistically significant(P<0.05).Significant inter-group differences existed in the declines of WBC at 6/12/24 hours.And the declines of serum levels of phosphorus,magnesium and total calcium were significantly higher in sodium citrate group than those in low-molecular-weight heparin group(P<0.05).Serum levels of phosphorus and magnesium dropped markedly in sodium citrate group while serum total calcium decreased obviously in low-molecular-weight heparin group.When the duration of dialysis was 6-12 hours,the prolongation of APTT/TT was significantly lower in sodium citrate group than that in low-molecular-weight heparin group.After treatment,no significant inter-group difference existed in the proportion of deceased patients,the recovery of renal function,the proportion of non-recovery of renal function or the proportion of patients with continuous dialysis(P>0.05).Conclusion Regional use of sodium citrate anticoagulation is not only safe,but also it lowers the inflammatory state in AKI patients in ICU on CRRT.