Abstract: 【Abstract】Objective To investigate the efficacy and safety of continuous renal replacement therapy (CRRT) using regional citrate anticoagulation in patients at high risk of bleeding. Methods A total of 40 patients at high risk of bleeding treated with CRRT in Fuzhou General Hospital of Nanjing Military Command during the period from Jan. 2014 to Jan. 2015 were enrolled in this study. They were divided into citrate group (n=20) and control group (n=20). Patients in citrate group were given citrate for anticoagulation, and patients in control group were given low molecular weight heparin for anticoagulation. The efficacy and safety were
compared between the two groups. Results Before treatment, there were no significant differences in demographic characteristics and laboratory data between the two groups (P＞0.05). After treatment at different time periods (12h, 24h and 72h), APTT in citrate group was lower than that in control group (F=83.280, 61.676 and 83.836, respectively; P＜0.01). Serum calcium, platelet and hemoglobin had no significant differences between the two groups (P＞0.05). Filter life was longer in citrate group than in control group (38.1±13.7h vs. 26.4±10.1h; t=0.381, P＜0.01). The incidence of clotting in circuit was lower in citrate group than in control group (12.8% vs. 29.2%; χ2=6.736, P＜0.01). The incidence of bleeding had no significant differences between the two groups (P＞0.05). In citrate group after the treatment at different time periods (12h and 24h), ionized calcium behind filter was lower than that before treatment (F=49.510, P＜0.01), pH (F=4.102, P＜0.05) and HCO3 - (F=4.502, P＜0.05) values were higher than those before treatment, and ionized calcium before filter changed insignificantly compared to that before treatment (P＞0.05). Conclusion Regional citrate anticoagulation is a safe and effective option for CRRT in patients at high risk of bleeding.

Key words: renal replacement therapy (CRRT), regional citrate anticoagulation, high risk of bleeding