Abstract: Objective To observe the effectiveness and safety of calcium-containing dialysate and replacement fluid with regional citrate anticoagulation in continuous renal replacement treatment (CRRT).  Methods  We prospectively recruited the patients treated with CRRT in West China Hospital of Sichuan University during January 2020 to December 2021. They were treated with the model of continuous veno-venous hemodiafiltration (CVVHDF) using citrate anticoagulation method. Blood access used the cuffed catheter in internal jugular vein or femoral vein. The initial blood flow was 150 ml/min, the rate of calcium-containing dialysate and replacement fluid was 1,000 ml/h, and 4% sodium citrate solution was pumped at the initial rate of 180 ml/h. Calcium ion was measured before and after the filtration at 0h, 6h, 12h, 24h and 48h. Lifespan of the extracorporeal circulation pipeline, treatment parameters and complications were collected. Results  A total of 28 patients were enrolled in this study, including 44 times of extracorporeal circulation pipeline and 42 times of scheduled CRRT. The average lifespan of the extracorporeal circulation pipeline was 44.0±24.6h, including the lifespan of <24h in 11 cases (26.2%), 24h ～ ＜48h in 13 cases (31.0%), and 48h ～≤72h in 18 cases (42.9%). There were no significant differences in the levels of calcium ion before filtration at 6h (t=0.612, P=0.969), 12h (t=0.456, P=0.625), 24h (t=0.848, P=0.298) and 48h (t=0.411, P=0.415), as compared with the baseline level at 0h. There were also no significant differences in the levels of calcium ion after filtration at 6h (t=0.294, P=0.774), 12h (t=0.246, P=0.405), 24h (t=0.191, P=0.853) and 48h (t=0.059, P=0.955), as compared with the level at 0h. Metabolic alkalosis was found in one patient (2.3%), and citric acid accumulation was found in one patient (2.3%).  Conclusion  The calcium-containing dialysate and replacement fluid with regional citrate anticoagulation for CRRT is effective and safe, and is suitable for the use of CRRT equipment with integrated citrate anticoagulation system. This method is worthy of further clinical application.

Key words: Calcium-containing replacement fluid, Citrate anticoagulant, Continuous renal replacement therapy