Zhonghua wei zhong bing ji jiu yi xue · 2026
[Analysis of influencing factors for citrate accumulation in critically ill patients with acute kidney injury undergoing continuous renal replacement therapy with regional citrate anticoagulation].
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Chen Zhongbin, Tang Qing, Xie Caixia, Cha Lei, Yang Qin, Zeng Bin, Chen Yanyu, Liao Dong, Huang Xinxin
Аннотация
OBJECTIVE: To investigate the influencing factors of citrate accumulation in critically ill patients with acute kidney injury (AKI) undergoing continuous renal replacement therapy with regional citrate anticoagulation (RCA-CRRT).
METHODS: A retrospective case-control study was conducted, enrolling AKI patients who received RCA-CRRT for ≥24 hours in the intensive care unit (ICU) of Sichuan Provincial People's Hospital from January 2023 to December 2024 as research subjects. Clinical data were collected, including gender, age, Sequential Organ Failure Assessment (SOFA) before RCA-CRRT initiation, mean blood lactic acid level, mean total bilirubin level from the start of RCA-CRRT to the occurrence of citrate accumulation, mean infusion dose of sodium citrate, mean partial pressure of arterial oxygen (PaO2), mean hourly volume of replacement or dialysate fluid, treatment dose, blood flow rate, treatment mode, and the occurrence of citrate accumulation during RCA-CRRT. Patients were divided into two groups based on the total calcium/ionized calcium ratio: a citrate accumulation group (≥2.5) and a non-citrate accumulation group (<2.5). Baseline data were compared between the two groups. Univariate and multivariate Cox proportional hazards regression analyses were used to screen the influencing factors of citrate accumulation. Cumulative risk curves of citrate accumulation were plotted to analyze the risk of citrate accumulation in different treatment modes [continuous veno-venous hemodialysis (CVVHD) vs. continuous veno-venous hemodiafiltration (CVVHDF)].
RESULTS: A total of 192 AKI patients were enrolled, with 393 circuits of RCA-CRRT treatment, among which citrate accumulation occurred in 134 circuits (34.1%). Univariate Cox proportional hazards analysis showed that treatment mode, total bilirubin level, sodium citrate dose, blood lactic acid level, PaO2, replacement fluid dose, treatment dose and SOFA score were potential influencing factors for citrate accumulation in AKI patients undergoing RCA-CRRT (all P<0.1). Multivariate Cox proportional hazards regression analysis revealed that CVVHD treatment mode [hazard ratio (HR)=2.329, 95% confidence interval (95%CI) was 1.396-3.884], elevated total bilirubin level (HR=1.004, 95%CI was 1.002-1.006), higher citrate dose (HR=1.001, 95%CI was 1.000-1.001) and elevated blood lactic acid level (HR=1.091, 95%CI was 1.036-1.148) were risk factors for citrate accumulation (all P<0.05), while elevated PaO2 was a protective factor (HR=0.990, 95%CI was 0.900-1.008, P<0.05). The cumulative risk curve of citrate accumulation indicated that the incidence of citrate accumulation in the CVVHD mode was significantly higher than that in the CVVHDF mode (P=0.001).
CONCLUSIONS: Higher total bilirubin, higher sodium citrate dose, higher lactate, and lower PaO2 are associated with an increased risk of citrate accumulation during RCA-CRRT. Compared with the CVVHD mode, the CVVHDF mode confers a lower risk of citrate accumulation in patients undergoing RCA-CRRT.
METHODS: A retrospective case-control study was conducted, enrolling AKI patients who received RCA-CRRT for ≥24 hours in the intensive care unit (ICU) of Sichuan Provincial People's Hospital from January 2023 to December 2024 as research subjects. Clinical data were collected, including gender, age, Sequential Organ Failure Assessment (SOFA) before RCA-CRRT initiation, mean blood lactic acid level, mean total bilirubin level from the start of RCA-CRRT to the occurrence of citrate accumulation, mean infusion dose of sodium citrate, mean partial pressure of arterial oxygen (PaO2), mean hourly volume of replacement or dialysate fluid, treatment dose, blood flow rate, treatment mode, and the occurrence of citrate accumulation during RCA-CRRT. Patients were divided into two groups based on the total calcium/ionized calcium ratio: a citrate accumulation group (≥2.5) and a non-citrate accumulation group (<2.5). Baseline data were compared between the two groups. Univariate and multivariate Cox proportional hazards regression analyses were used to screen the influencing factors of citrate accumulation. Cumulative risk curves of citrate accumulation were plotted to analyze the risk of citrate accumulation in different treatment modes [continuous veno-venous hemodialysis (CVVHD) vs. continuous veno-venous hemodiafiltration (CVVHDF)].
RESULTS: A total of 192 AKI patients were enrolled, with 393 circuits of RCA-CRRT treatment, among which citrate accumulation occurred in 134 circuits (34.1%). Univariate Cox proportional hazards analysis showed that treatment mode, total bilirubin level, sodium citrate dose, blood lactic acid level, PaO2, replacement fluid dose, treatment dose and SOFA score were potential influencing factors for citrate accumulation in AKI patients undergoing RCA-CRRT (all P<0.1). Multivariate Cox proportional hazards regression analysis revealed that CVVHD treatment mode [hazard ratio (HR)=2.329, 95% confidence interval (95%CI) was 1.396-3.884], elevated total bilirubin level (HR=1.004, 95%CI was 1.002-1.006), higher citrate dose (HR=1.001, 95%CI was 1.000-1.001) and elevated blood lactic acid level (HR=1.091, 95%CI was 1.036-1.148) were risk factors for citrate accumulation (all P<0.05), while elevated PaO2 was a protective factor (HR=0.990, 95%CI was 0.900-1.008, P<0.05). The cumulative risk curve of citrate accumulation indicated that the incidence of citrate accumulation in the CVVHD mode was significantly higher than that in the CVVHDF mode (P=0.001).
CONCLUSIONS: Higher total bilirubin, higher sodium citrate dose, higher lactate, and lower PaO2 are associated with an increased risk of citrate accumulation during RCA-CRRT. Compared with the CVVHD mode, the CVVHDF mode confers a lower risk of citrate accumulation in patients undergoing RCA-CRRT.