Efficacy and safety of regional citrate anticoagulation in patients with severe liver diseases and acute kidney injury receiving continuals renal replacement therapy

Objective To investigate the efficacy and safety of regional citrate anticoagulation(RCA) in patients with severe liver diseasesand acute kidney injury(AKI) receiving continuous renal replacement therapy(CRRT).Methods A retrospective analysis was performedfor the medical records and first-time CRRT data of 175 liver disease patients with AKI(liver disease group) and 285 non-liver diseasepatients with AKI(non-liver disease group) who underwent RCA-CRRT in Beijing You' an Hospital and Beijing Friendship Hospital,Capital Medical University, from January 2016 to March 2019. The two groups were compared in terms of the changes in hepatic and renalfunction markers, blood gas parameters, lactic acid, ionized calcium(iCa2+), and total calcium(tCa2+) after treatment, as well as themean operation life of filter and adverse reactions. The pairedt-test or the independent samplest-test was used for comparison of normallydistributed continuous data between two groups, and the Mann-WhitneyUtest was used for comparison of non-normally distributed contin-uous data between two groups; the chi-square test was used for comparison of categorical data between two groups. The Kaplan-Meier sur-vival curve was used to analyze the operation life of filter in the two groups, and the log-rank test was used for comparison.Results BeforeCRRT, the level of ALT、AST、TBil、BUN in liver disease group were significantly higher than those in non-liver disease group(allP<0. 05). After treatment, iCa2+, tCa2+, pH value, and base excess basically returned to normal, and there were significant differences inthe same group before and after treatment(allP< 0. 05). Compared with the non-liver disease group, the liver disease group had a signifi-cantly higher incidence rate of citrate accumulation(tCa2+/iCa2+>2. 5) during treatment(12% vs 2. 2%,χ2 =18.65,P< 0. 001).There was no significant difference in the mean operation life of filter between the liver disease group and the non-liver disease group(32. 20 ± 24. 99 h vs 32. 96 ± 18. 93 h,t =0.346,P> 0. 05) and there was also no significant difference in the 48-hour survival rate withfilter between the two groups(28. 1% vs 26. 9%,χ2 =1.356,P= 0. 381). No adverse reaction associated with citrate accumulation wasobserved.Conclusion In patients with severe liver diseases, although RCA used in CRRT may induce a high incidence rate of citrate accu-mulation, it can achieve a satisfactory anticoagulant effect and is relatively safe.