Benedito Jorge Pereira, Germana Brito, Joubert Alves, Aline Baptista, Luis A Silvestre, Marina H Imanishe
The use of citrate as regional anticoagulation in the sustained low extended dialysis (SLED) in cancer patients with coagulation disorders tends to be much used, yet it is important to note that particularities which may be subject those patients with multiple clinical factors complicating. Aims: Check the clinical and laboratory characteristics of cancer patients using trisodium citrate in SLEDs; check the particularities of cancer dialysis patients using regional anticoagulation and assess the need for calcium replacement EV in SLED with regional citrate anticoagulation.
Observational, retrospective cohort study through the electronic medical record, with clinical and laboratory data of patients undergoing SLEDs with using regional citrate anticoagulation. The ionic calcium samples were taken before the start of SLED, the 1st hour (h) and thereafter every 6 h (pre-capillary sample and post-capillary) .Information on dialysis were checked as dialysis time, complications (clotting system, hypotension, malfunction access), EV calcium replacement need. Statistical analysis performed by SPSS program with Chi-square test and Pearson’s correlation. Data described in percentage, mean and standard deviation and considered significant if p <0.05.
Were evaluated 48 dialysis with citrate in 19 patients with the prevalence of hematologic disease in 45.8%, 89.6% in AKI, CKD terminal at 10.4% , using temporary catheter in 85.7%. Indications citrate were for thrombocytopenia in 57.8%, active bleeding in 33.3%, access passage or surgical procedure prior to SLED by 31.1%, 33.3% in active bleeding and liver failure in 14.6%. During the procedure, there was some complication of dialysis in 29.2% (n = 14), bad access flow in 18.8%, 16.3% hypotension and clotting in 10.2%. It was only necessary to replace calcium in one patient (2.1%) after the procedure and the long run average was 5.53 ± 1.77 h. The problems occurred more frequently in patients with tumors of solid organs (92.9 vs 41.2%), undergoing anticoagulation (23.1% vs 3.2%), with a prescribed time 8 h (35.7%) and malfunctioning access (50% vs 6.1%). The patients had a higher death rate (71.4% vs 35.3%). Moreover, Cai had higher precapillary (1.17 ± 0.16 mg / dl vs 1.11 ± 0.81 mg / dl), higher platelet counts (87 492 ± 158 071) and dialysis time held lower (4.33 ± 2.97 vs 6.03 ± 0.39 h) .The coagulation occurred more often in patients with hepatic failure (37.5% vs. 10%), higher platelet counts (87 122 ± 175 250) shortening dialysis time 2.71 ± 2.88 h.
in cancer patients the presence of complications in SLED with citrate occurred more in those with tumors of solid organs, even if undergoing anticoagulation and malfunctioning of access, the system clotting was the main complication and was more related to this malfunction access, serum levels of pre-capillary Cai and higher platelet count resulting in a significant reduction in the duration of dialysis.