Construction of a coagulation prediction model of the extracorporeal circulation circuit during hemodialysis with regional citrate anticoagulant (RCA)
Research article published in The International journal of artificial organs (2024)
Abstract
OBJECTIVE: To construct a prediction model of coagulation in the extracorporeal circulation circuit during hemodialysis with regional citrate anticoagulant(RCA) conditions. METHODS: This was a single-center, retrospective study. The clinical data of patients who received hemodialysis with RCA from February 2021 to March 2022 were collected. The risk predictors of coagulation in the extracorporeal circulation circuit were screened by LASSO regression. On this basis, we used multivariate logistic regression analysis to establish a nomogram prediction model. RESULTS: A total of 98 patients received RCA hemodialysis for 362 times. Among them, 155 treatments with complete data were included in the study. Among the 155 treatments, coagulation of the extracorporeal circulation circuit occurred 12 times. The use of arteriovenous fistulas(AVF), the venous pressure at 4 h after hemodialysis initiation, blood flow velocity, dialyzer manufacturer, Systemic iCa2+ at 1 h after hemodialysis initiation, plasma albumin level, and plasma d-dimer level were influencing factors of coagulation in the extracorporeal circuit during hemodialysis with RCA (p < 0.05). A nomogram model was made out of the above indicators. The area under the receiver operating characteristic (ROC) curve for predicting coagulation in the circuit was 0.967 (95% CI: 0.935-0.998). The internal validation result of the memory testing (bootstrap method) showed that the area under the ROC curve was 0.967 (95% CI: 0.918-0.991). CONCLUSION: The nomogram model has good discrimination and calibration and can intuitively and succinctly predict the risk of coagulation in the extracorporeal circulation circuit during hemodialysis with RCA.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Peer-reviewed clinical and outcomes research relevant to medicinal leech therapy and its biology. Indexed in PubMed and verified against the NCBI record.
Why This Matters for Hirudotherapy
This single-center retrospective study used LASSO and multivariate logistic regression to build a nomogram predicting clotting of the extracorporeal circuit during hemodialysis under regional citrate anticoagulation, drawing on 155 completed treatments (in which circuit coagulation occurred 12 times) and identifying factors such as access type, post-initiation venous pressure, blood-flow velocity, dialyzer, ionized calcium, albumin, and d-dimer, with a reported area under the ROC curve of 0.967. Its relevance to hirudotherapy is contextual rather than direct: it illustrates the persistent clinical problem of controlling extracorporeal and local clotting, the same coagulation biology that the leech's hirudin and other salivary anticoagulants act upon, and reinforces why robust anticoagulant strategies remain a research priority. Honest caveat: this is a small, single-center retrospective predictive-modeling study with only 12 outcome events and internal validation only; it involves no leech product and the high AUC has not been externally validated, so it should not be read as evidence about hirudotherapy.
Citation
Construction of a coagulation prediction model of the extracorporeal circulation circuit during hemodialysis with regional citrate anticoagulant (RCA).
Gong et al. · The International journal of artificial organs, 2024
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