Heparin anticoagulation versus regional citrate anticoagulation for membrane therapeutic plasma exchange in patients with increased bleeding risk

Figures & data

Figure 1. Patient inclusion flow chart.

mTPE: membrane therapeutic plasma exchange. HA: heparin anticoagulation. RCA: regional citrate anticoagulation.

Table 1. Patients baseline characteristics.

Patients baseline characteristics
	Total (n = 108)	HA Group (n = 38)	RCA Group (n = 70)	P
Sessions	368	73	295
Age (year)	51 ± 15	50 ± 17	52 ± 17	0.576
Sex (male)	65 (60.2%)	27 (71%)	38 (54.3%)	0.169
BMI	21.9 ± 3.55	21.9 ± 2.92	22 ± 3.98	0.992
MAP (mmHg)	92.7 ± 15.5	88.2 ± 15	99.1 ± 15.2	0.007
SOFA score	6.7 ± 3.3	7.2 ± 3.6	7 ± 2.8	0.825
GCS score	14.2 ± 1.83	13.3 ± 2.7	14.7 ± 0.8	0.004
Use of vasopressors (n/%)	8 (7.4%)	4 (10.5%)	4 (5.7%)	0.362
Mechanical ventilation (n/%)	10 (9.3%)	5 (13.2%)	5 (7.1%)	0.303
Reasons of increased bleeding risk
PLT < 40 × 10^9/L (n/%)	46 (42.5%)	13 (34.2%)	33 (47.1%)	0.194
INR > 1.5 (n/%)	32 (29.6%)	15 (39.5%)	17 (24.3%)	0.099
APTT > 60 s (n/%)	12 (11.1%)	8 (21.1%)	4 (5.7%)	0.015
Active bleeding within 7d (n/%)	22 (20.3%)	9 (23.7%)	13 (18.6%)	0.529
Pulmonary hemorrhage	12 (54.55%)	2 (22.2%)	10 (76.9%)
Gastrointestinal hemorrhage	2 (9.09%)	2 (22.2%)	–
Vaginal bleeding	1 (4.55%)	1 (11.1%)	–
Subcutaneous hemorrhage	4 (18.18%)	3 (33.3%)	1 (7.7%)
Hemorrhagic drainage fluid	2 (9.09%)	1 (11.1%)	1 (7.7%)
Hematuresis	1 (4.55%)	–	1 (7.7%)
Trauma or surgery within 7d (n/%)	22 (20.3%)	7 (18.4%)	15 (21.4%)	0.711
Liver puncture	1 (4.55%)	1 (2.63%)	–
Cardiosurgery	4 (18.18%)	2 (5.26%)	2 (2.86%)
Exploratory laparotomy	2 (9.09%)	1 (2.63%)	1 (1.43%)
Cesarean section	2 (9.09%)	1 (2.63%)	1 (1.43%)
Percutaneous renal biopsy	10 (45.45%)	1 (2.63%)	9 (12.86)
Catagma	2 (9.09%)	–	2 (2.86%)
Arteriovenostomy	1 (4.55%)	–	1 (1.43%)
Vascular access
Femoral vein (n/%)	287 (77.9%)	65 (89%)	222 (75.2%)	0.032
Internal jugular (n/%)	77 (20.9%)	8 (10.9%)	69 (23.3%)
Arteriovenous fistula (n/%)	4 (1%)	–	4 (1.3%)
Blood flow (mL/min)	120	120	120
Filtrated plasma flow (mL/min)	19.8 ± 0.57	19.8 ± 0.36	19.8 ± 0.6	0.992
Effective replacement plasma volume (mL)	1999.8 ± 90.8	1999.7 ± 2.34	1999.8 ± 101	0.718
Effective treatment duration (h)	2.35 ± 0.37	2.38 ± 0.36	2.37 ± 0.37	0.277
Unfractionated heparin (mg)	–	9.5 ± 2.7	–
Citrate (mL/h)	–	–	113.8 ± 19.7
PT (s)	12.2 (11.1, 18.55)	13.05 (11.275, 33.15)	11.95 (11, 15.4)	0.039
APTT (s)	38.7 (27, 45.6)	36.6 (11.3, 33.2)	31.1 (27, 44.6)	0.186
INR	1.06 (0.96, 1.59)	1.13 (0.98, 2.93)	1.05 (0.96, 1.35)	0.055
PLT (10^9/L)	94 (19.8, 176.8)	114.5 (33.3, 177.5)	49.5 (10, 177.8)	0.115
TBIL (μmol/L)	33.1 (13.3, 99.8)	47.5 (15.4, 127.9)	22.95 (12.3, 82.3)	0.093
SCR (μmol/L)	124.5 (79.3, 384)	113.5 (78.8, 292.3)	128.5 (78.8, 462)	0.475

APTT: activated partial thromboplastin time; GCS scores: Glasgow Coma Scale scores; INR: international normalized ratio; MAP: mean artery pressure; PT: prothrombin time; PLT: blood platelet; SCR: serum creatinine; SOFA scores: Sequential organ failure assessment; TBIL: total bilirubin.

Table 2. Distribution of etiologies.

Distribution of etiologies	HA Group		RCA Group
	Patients	Sessions	Patients	Sessions
Diagnosis	(n /%)	(n /%)	(n /%)	(n /%)
Multiple myeloma	1 (2.63%)	1 (1.3%)	1 (1.43%)	1 (0.3%)
Polymyositis	1 (2.63%)	2 (2.7%)	1 (1.43%)	2 (0.6%)
Acute liver failure	18 (47.37%)	26 (35.6%)	14 (20%)	31 (10.5%)
Anti-GBM disease	1 (2.63%)	2 (5.1%)	8 (11.43%)	63 (21.6%)
Thrombotic microangiopathy	9 (23.68%)	32 (43.8%)	22 (31.43%)	101 (34.2%)
Heavy metal poisoning	4 (10.53%)	4 (5.4%)	1 (1.43%)	1 (0.3%)
Thermoplegia	2 (5.26%)	2 (2.7%)	–	–
HELLP syndrome	1 (2.63%)	1 (1.3%)	–	–
ANCA-associated vasculitis	–	–	13 (18.57%)	54 (18.3%)
Guillain-barre Syndrome	–	–	1 (1.43%)	3 (1%)
Antiphospholipid syndrome	–	–	4 (5.71%)	28 (9.4%)
Dermatitis medicamentosa	–	–	1 (1.43%)	1 (0.3%)
Systemic lupus erythematosus	–	–	5 (7.14%)	10 (3.3%)

Table 3. Comparison of the treatment-related complications with different methods of anticoagulation.

Bleeding episodes, transfusion, allergy or hypocalcemia related manifestations
	Total (n = 108)	HA Group (n = 38)	RCA Group (n = 70)	P
Bleeding episodes (Patients, n/%)	13 (12%)	10 (26.3%)	3 (4.3%)	<0.001
Sessions (n/%)	25 (6.8%)	12 (16.4%)	13 (4.4%)
Hemoptysis (n /%)	5 (1.4%)	2 (2.7%)	3 (1%)
Subcutaneous hemorrhage (n /%)	13 (3.5%)	5 (6.8%)	8 (2.7%)
Gastrointestinal bleeding (n /%)	5 (1.4%)	4 (5.5%)	1 (0.3%)
Vascular access site bleeding (n /%)	2 (0.5%)	1 (1.4%)	1 (0.3%)
Postoperative transfusion within 24 hours (Patients, n/%)	13 (12%)	7 (18.4%)	6 (8.6%)	0.133
Sessions (n/%)	18 (4.9%)	8 (11%)	10 (3.4%)	0.007
Patients with FFP infusion (n/%)	11 (10.2%)	6 (15.8%)	5 (7.1%)
FFP, mL (range)	4070	2200	1870
Patients with PLT infusion (n/%)	9 (8.3%)	5 (13.2%)	4 (5.7%)
PLT, units (range)	101	50	51
Patients with RBC infusion (n/%)	8 (7.4%)	2 (5.3%)	6 (8.6%)
RBC, units (range)	22	4	18
Patients with cryoprecipitate infusion (n/%)	4 (3.7%)	3 (7.9%)	1 (1.4%)
Cryoprecipitate, units (range)	50	40	10
Allergy related manifestations (Patients, n/%)	8 (7.4%)	–	8 (11.4%)	0.048
Sessions (n/%)	12 (3.2%)	–	12 (4%)	0.134
Cutaneous pruritus (n /%)	10 (2.7%)	–	10 (3.4%)
Erythra (n /%)	4 (1.1%)	–	4 (1.4%)
Hypocalcemia related manifestations (Patients, n/%)	6 (5.6%)	1 (2.6%)	5 (7.1%)	0.422
Sessions (n/%)	6 (1.6%)	1 (1.4%)	5 (1.7%)	1.000
Perioral numbness (n /%)	4 (1.1%)	1 (1.4%)	3 (1%)
Limb anesthesia (n /%)	3 (0.8%)	–	3 (1%)

Table 4. Comparison of laboratory index, SOFA scores, and vital signs before and after HA or RCA-mTPE treatment.

Laboratory index, SOFA score and Vital signs
	HA Group			RCA Group			HA	RCA	Δ
Index	Prior treatment	Post treatment	Δ	Prior treatment	Post treatment	Δ	P	P	P
PT (s)	13.8 (11.9,20.7)	12.6 (11.6,17)	−0.6 (−3.75,0.05)	12 (11, 13.9)	11.6 (10.6, 13.7)	−0.5 (−1.23,0.2)	0.24	0.069	0.211
APTT (s)	39.4 (30.2,53.9)	40.5 (30.9,54.4)	0.6 (−6,6.65)	29 (24.7, 38.8)	28 (24, 38.2)	−0.45 (−5.1,1.83)	0.862	0.335	0.396
INR	1.21 (1.03,1.875)	1.1 (1.01,1.54)	−0.04 (−0.37,0.02)	1.05 (0.96, 1.2)	1.02 (0.93, 1.2)	−0.05 (−0.12, 0.02)	0.327	0.066	0.299
RBC (109/L)	2.97 ± 1.09	2.9 ± 1.06	−0.07 (−0.245, 0.1)	2.7 ± 0.78	2.67 ± 0.76	−0.04 (−0.22, 0.16)	0.188	0.144	0.676
HB (g/L)	91.3 ± 32.7	90 ± 31.7	−1 (−7.5, 4)	84.5 ± 25.6	84.6 ± 27.2	−1 (−7, 6)	0.403	0.886	0.511
PLT (109/L)	44 (20, 101.5)	48 (26, 105.5)	1 (−9, 15.5)	72.5 (22.75, 180)	81.5 (28.8, 179.3)	2 (−9, 17)	0.442	0.381	0.729
HCT (%)	25.5 (18.9, 35)	24.8 (19.6, 32.6)	−0.2 (−1.95, 1.2)	24.5 (21.3, 28.5)	24.8 (21.2, 28.5)	−0.15 (−1.7, 1.9)	0.847	0.931	0.636
TBIL (μmol/L)	86.7 (31.5, 250)	110 (17.1, 242)	−7.35 (−22.4, 0)	20.2 (11.3, 53.3)	17.3 (11.3, 37.8)	−1.1 (−7.9, 2.3)	0.584	0.465	0.022
SCR (μmol/L)	107.5 (87.5, 173)	103.5 (82.5, 168)	−5 (−37, 9.5)	126 (83.5, 356)	126 (84.5, 309)	−4 (−24.5,6)	0.625	0.695	<0.001
SOFA score	9.3 ± 3.5	8.9 ± 3.5	−0.5 (−1, 0)	6 ± 3	6.2 ± 2.8	0 (-1, 1)	0.059	<0.001	0.001
MAP (mmHg)	86 ± 14	86 ± 12	0 (−7,8)	92 ± 13	92 ± 13	0 (-5, 3)	0.798	0.4	0.597
HR (times/min)	86 ± 16	85 ± 16	−1 (−7, 2)	84 ± 16	84 ± 15	0 (-5, 4)	0.248	0.71	0.286

APTT: activated partial thromboplastin time; HB: hemoglobin; HR: heart rate; HCT: Hematocrit value; INR: international normalized ratio; MAP: mean arterial pressure; PT: prothrombin time; PLT: blood platelet; RBC: red blood cell; SCR: serum creatinine; SOFA scores: Sequential Organ Failure Assessment; TBIL: total bilirubin; Δ=Post-treatment - Prior treatment; Effective sessions in blood routine index, coagulation, liver or renal function, SOFA scores and vital signs (65, 45, 56, 73 vs. 254, 126, 217, 295; HA vs. RCA).

Table 5. Comparison of the incidence of electrolyte and acid-base disturbances before and after HA or RCA-mTPE treatment.

Metabolic alkalosis, acidosis, hypocalcemia, hypernatremia, TCa/iCa > 2.5, and CA
	HA Group (n = 5)	RCA Group (n = 22)	p
Metabolic alkalosis (Prior treatment, n /%)	–	19 (25.7%)	0.061
Metabolic alkalosis (Post-treatment, n /%)	2 (16.7)	40 (54.1%)	0.027
P	0.478	0.001
Acidosis (Prior treatment, n /%)	1 (8.3%)	–	0.14
Acidosis (Post-treatment, n /%)	1 (8.3%)	–
P	1.000
Hypocalcemia (Prior treatment, n /%)	–	11 (14.9%)	0.349
Hypocalcemia (Post-treatment, n /%)	5 (41.7%)	66 (89.2%)	0.001
P	0.037	<0.001
Hypernatremia (Prior treatment, n /%)	–	–
Hypernatremia (Post-treatment, n /%)	–	2 (3.4%)	1.000
P		0.496
TCa/iCa > 2.5 (Prior treatment, n /%)	–	1 (1.35%)	1.000
TCa/iCa > 2.5 (Post-treatment, n /%)	–	4 (5.4%)	1.000
P		0.366
CA (Prior treatment, n /%)	–	–
CA (Post-treatment, n /%)	–	–
P

*In the RCA group, one patient with 15 sessions who existed multiply hypernatremia before the first treatment was excluded, the effective sessions were 59 in assessment of incidence of hypernatremia.

Table 6. Comparison of changes in acid-base and electrolyte before and after HA or RCA-mTPE treatment.

Acid-base and	HA Group			RCA Group			HA	RCA	Δ
Electrolyte	Prior treatment	Post-treatment	Δ	Prior treatment	Post-treatment	Δ	p	p	p
PH	7.39 ± 0.06	7.39 ± 0.08	0 (−0.04,0.04)	7.43 ± 0.04	7.46 ± 0.03	0.02 (0.01,0.04)	0.619	<0.001	0.067
iCa (mmol/L)	1.24 ± 0.06	1.16 ± 0.17	−0.06 (−0.23,0.04)	1.18 ± 0.13	0.93 ± 0.16	−0.23 (−0.32, −0.19)	0.077	<0.001	0.002
TCa (mmol/L)	2.11 ± 0.22	2.09 ± 0.18	−0.07 (−0.15,0.01)	1.95 ± 0.36	1.95 ± 0.28	−0.02 (−0.1,0.06)	0.633	0.987	0.69
TCa/iCa	1.71 ± 0.16	1.83 ± 0.26	0.05 (−0.1,0.4)	1.67 ± 0.36	2.17 ± 0.54	0.4 (0.3,0.6)	0.183	<0.001	0.024
HCO3^- (mmol/L)	25.2 ± 2.28	25 ± 3.2	−0.5 (-1.7,1.6)	27.3 ± 2.82	29.1 ± 2.7	1.85 (0.75,2.93)	0.808	<0.001	0.002
BE (mmol/L)	1.25 (−1.325, 2.875)	−2.05 (−2.825,4.85)	−0.85 (−2.2,2.2)	3.4 (0.95, 6.6)	5.9 (3.6, 8.63)	2.5 (1,3.83)	0.59	0.005	0.22
AG (mmol/L)	12.3 ± 4.1	12.2 ± 6.5	−2 (−3.5,1.7)	12.6 ± 4.3	12 ± 4.4	−0.15 (−2.9,2)	0.924	0.249	0.526
Na+ (mmol/L)	138.2 ± 3.48	139.7 ± 2.39	1.25 (−0.7, 4.65)	139.5 ± 4.7	140.4 ± 5.7	0.1 (−1.15, 2.325)	0.137	0.091	0.612
K+ (mmol/L)	4.02 ± 0.4	4.06 ± 0.41	0.02 (−0.32, 0.34)	3.85 ± 0.4	3.88 ± 0.49	0.01 (-1.1, 0.28)	0.747	0.554	0.751

AG: anion gap; BE: base excess; HCO3^-: serum bicarbonate; iCa: ionized calcium; Tca: total calcium.

*In the RCA group, the post-filter ionized calcium level was 0.39 ± 0.1 mmol/L in mTPE treatment for 1h.

Table 7. Predictors of bleeding episodes in patients with increased bleeding risk underwent mTPE treatment.

Predictors of bleeding episodes for mTPE in patients with increased bleeding risk
Univariate analysis
Value	Univariate analysis OR (95%CI)	p
Age	0.981 (0.957–1.005)	0.125
Sex	1.327 (0.58–3.036)	0.503
BMI	0.927 (0.837–1.027)	0.147
Femoral vein	–	0.809
Internal jugular	–	0.999
Arteriovenous Fistula	–	0.999
Anticoagulation strategy (HA vs. RCA)	4.267 (1.857–9.806)	0.001
Active bleeding within 7d	0.291 (0.09–0.937)	0.038
Trauma or surgery within 7d	–	0.997
APTT > 60s	0.449 (0.144–1.401)	0.168
PLT<40	0.701 (0.311–1.58)	0.391
INR > 1.5	0.579 (0.232–1.444)	0.241
HR	1.009 (0.985–1.035)	0.46
MAP	1.04 (1.009–1.072)	0.012
Use of vasopressors	1.098 (0.139–8.665)	0.93
Mechanical ventilation	0.854 (0.281–2.597)	0.781
SOFA scores	1.113 (0.977–1.267)	0.106
PT	1.003 (0.964–1.045)	0.866
APTT	1.002 (0.975–1.029)	0.903
INR	1.016 (0.668–1.545)	0.941
RBC	1.319 (0.839–2.074)	0.230
HCT	0.998 (0.957–1.039)	0.909
PLT	0.998 (0.993–1.003)	0.473
HGB	1.004 (0.99–1.019)	0.554
TBIL	1.001 (0.997–1.004)	0.654
SCR	1.000 (0.998–1.003)	0.841
Multivariate analysis
Value	Multivariate analysis OR (95%CI)	P	Value	Multivariate analysis adjusted the important clinical parameters OR (95%CI)	p
Anticoagulation strategy	5.659 (2.266–14.129)	<0.001	Anticoagulation strategy	5.209 (1.474—18.404)	0.010
(HA vs. RCA)			(HA vs. RCA)
Mean arterial pressure	1.052 (1.019–1.086)	0.002	Mean arterial pressure	1.084 (1.039–1.131)	<0.001
(Prior treatment)			(Prior treatment)
Active bleeding within 7d	0.477 (0.131–1.74)	0.262	Active bleeding within 7d	0.582 (0.104–3.251)	0.538
–	–	–	APTT (Prior treatment)	0.997 (0.95–1.047)	0.906
–	–	–	INR (Prior treatment)	0.867 (0.407–1.848)	0.712
–	–	–	PLT (Prior treatment)	0.997 (0.991–1.003)	0.350

Table

Appendix Table 1. In patients with acute liver failure
Patients baseline characteristics
	HA Group (n = 18)	RCA Group (n = 14)	p
Sessions	26	31
Age (year)	50 ± 17	52 ± 17	0.638
Sex (male)	18 (100%)	11 (78.5%)	0.073
BMI	22.2 ± 3	22.8 ± 3.93	0.616
MAP (mmHg)	80.3 ± 1.8	95.8 ± 9.36	0.007
SOFA score	8.9 ± 1.4	12.1 ± 0.3	0.224
MELD score	17.9 (7.5, 29.8)	20.1 (13.3, 35.7)	0.512
Use of vasopressors (n/%)	4 (22.2%)	4 (28.5%)	0.703
Mechanical ventilation (n/%)	2 (11.1%)	3 (21.4%)	0.631
Survival rate (n/%)	9 (50%)	11 (78.5%)	0.147
Vascular access
Femoral vein (n/%)	23 (88.4%)	27 (87%)	1.000
Internal jugular (n/%)	3 (11.5%)	4 (12.9%)
Blood flow (mL/min)	120	120
Filtrated plasma flow (mL/min)	19.95 ± 0.22	19.5 ± 1	0.009
Effective replacement plasma volume (mL)	1999.2 ± 3.92	1973.9 ± 107.3	0.198
Effective treatment duration (h)	2.16 ± 0.41	2.2 ± 0.34	0.290
Unfractionated heparin (mg)	10.2 ± 2.6	–
Citrate (mL/h)	–	94.6 ± 19.5
PT (s)	18.4 (12.65, 65.3)	21.05 (12, 42.9)	0.506
APTT (s)	46.2 (34.8, 80.3)	47.9 (32.8, 56)	0.282
INR	1.57 (1.1, 5.66)	2.08 (1.05, 4.2)	0.628
PLT (10^9/L)	146 (99, 180)	45 (38, 117)	0.029
TBIL (μmol/L)	103.4 (27.9, 238.2)	216.1 (133.6, 312.7)	0.172
SCR (μmol/L)	94 (81, 251.8)	80.5 (65.5, 283.5)	0.854

Table

Appendix Table 2. Bleeding episodes, transfusion, anaphylactic reaction, and symptomatic hypocalcemia
	HA Group (n = 18)	RCA Group (n = 14)	p
Clotting of extracorporeal circuits (Treatment interruption, n/%)	0 (0%)	2 (6.4%)	0.495
Bleeding episodes (Patients, n/%)	7 (38.9%)	1 (7.1%)	0.104
Sessions (n/%)	7 (26.9%)	1 (3.2%)	0.039
Hemoptysis (Session, n /%)	–	–
Subcutaneous hemorrhage (Session, n /%)	2 (7.7%)	1 (3.2%)
Gastrointestinal bleeding (Session, n /%)	4 (15.4%)	–
Vascular access site bleeding (Session, n /%)	1 (3.85%)	–
Postoperative transfusion within 24 hours (Patients, n/%)	4 (22.2%)	–	0.017
Sessions (n/%)	4 (15.4%)	–	0.038
Patients with FFP infusion (n/%)	4 (15.4%)	–
FFP, mL (range)	1600	–
Patients with PLT infusion (n/%)	1 (5.56%)	–
PLT, units (range)	10	–
Patients with RBC infusion (n/%)	–	–
RBC, units (range)	–	–
Patients with cryoprecipitate infusion (n/%)	2 (7.7%)	–
Cryoprecipitate, units (range)	20	–
Allergy related manifestations (Patients, n/%)	–	–
Sessions (n/%)	–	–
Cutaneous pruritus (Session, n /%)	–	–
Erythra (Session, n /%)	–	–
Hypocalcemia related manifestations (Patients, n/%)	–	–
Sessions (n/%)	–	–
Perioral numbness (Session, n /%)	–	–
Limb anesthesia (Session, n /%)	–	–

Table

Appendix Table 3. Laboratory index, SOFA score and Vital signs
	HA			RCA			HA	RCA	ΔP
Index	Prior treatment	Post treatment	Δ	Prior treatment	Post-treatment	Δ	p	p	P
PT (s)	18.7 (14.35, 23.95)	16.1 (13.8, 22.7)	−2.4 (-5.1, −0.1)	18.3 (12.3, 22.9)	16.6 (12.3, 20.6)	−0.6 (−3.15, 0)	0.242	0.283	0.21
APTT (s)	48 (40.25, 58.35)	49 (39.9, 62.6)	−0.2 (-10.65, 6.35)	38.6 (29.35, 46.2)	37.8 (30.33, 45.8)	0.7 (−5.85, 4.15)	0.92	0.923	0.344
INR	1.69 (1.29, 2.17)	1.45 (1.21, 2)	−0.26 (−0.49, 0.03)	1.61 (1.07, 2.13)	1.48 (1.07, 1.9)	−0.06 (−0.24, −0.01)	0.258	0.314	0.236
PLT (109/L)	65.5 (26, 105.8)	66 (26.5, 112)	0 (−11.5, 8.75)	39 (27, 73)	41 (26, 52)	2 (−10, 12)	0.73	0.176	0.723
TBIL (μmol/L)	297.6 (174.1, 383.9)	266.7 (168.7, 325.6)	−16.85 (-53,-0.025)	257.4 (215.6, 355.7)	257.4 (193.7, 355.7)	−19.3 (−61.5, 20.5)	0.483	0.693	0.525
SCR (μmol/L)	107 (67, 161.8)	109 (66.25, 178.5)	1 (−14, 15.25)	92 (69, 298)	92 (68, 235)	−3 (−16, 2)	0.942	0.719	0.855
SOFA score	11.25 ± 3.42	11.2 ± 3.06	0 (-1,1)	7.65 ± 3.27	10.1 ± 2.66	3 (0,4)	0.78	<0.001	<0.001
MELD score	20.3 ± 8.94	19.3 ± 7.68	−2.02 (−3.98, 0.1)	18.2 ± 9.43	16.4 ± 9.65	−1.2 (−5.3, −0.35)	0.035	0.015	0.868
MAP (mmHg)	84.3 ± 18	86.2 ± 14.4	1 (−7.5, 9)	83 ± 12	85 ± 11	−3 (−7,3)	0.478	0.329	0.98
HR (times/min)	93 ± 17	90 ± 18	−1 (−7.25, 2)	86 ± 17	87 ± 17	−3 (−5,3)	0.095	0.075	0.464

Table

Appendix Table 4. Acid-base and Electrolyte
	HA (7 sessions)		RCA (10 sessions)		HA	RCA	Δp
Index	Prior treatment	Post treatment	Prior treatment	Post-treatment	P	p
PH	7.37 ± 0.07	7.35 ± 0.07	7.44 ± 0.04	7.44 ± 0.04	0.276	0.926	0.231
iCa (mmol/L)	1.26 ± 0.05	1.29 ± 0.07	1.22 ± 0.09	0.84 ± 0.21	0.41	<0.001	<0.001
TCa (mmol/L)	2.24 ± 0.1	2.16 ± 0.11	1.8 ± 0.53	1.75 ± 0.5	0.052	0.022	0.604
TCa/iCa	1.77 ± 0.08	1.67 ± 0.1	1.47 ± 0.4	2.22 ± 0.93	0.027	0.014	0.012
HCO3^- (mmol/L)	24 ± 2.36	22.6 ± 0.94	28.1 ± 2.75	28.3 ± 1.82	0.061	0.81	0.159
BE (mmol/L)	−1.1 (−2.1, 0.2)	−2.3 (−4.4, 2.1)	3.7 (1.35, 7.45)	5 (3.25, 5.6)	0.038	0.436	0.072
AG (mmol/L)	14.7 ± 2.84	16.7 ± 3.02	11.6 ± 4.84	12.5 ± 3.04	0.246	0.566	0.693
Na+ (mmol/L)	138.8 ± 3.86	140.2 ± 2.8	136.5 ± 3.86	136.9 ± 4.5	0.423	0.752	0.627
K+ (mmol/L)	4.23 ± 0.31	4.2 ± 0.39	3.76 ± 0.37	3.69 ± 0.29	0.809	0.484	0.908

Table

Appendix Table 5. Metabolic alkalosis, acidosis, hypocalcemia, hypernatremia, TCa/iCa > 2.5, and CA
	HA Group	RCA Group	p
Metabolic alkalosis (Prior treatment, n /%)	1 (14.3%)	1 (10%)	1.000
Metabolic alkalosis (Post treatment, n /%)	–	4 (40%)	0.255
P	1.000	0.302
Acidosis (Prior treatment, n /%)	2 (8.3%)	–	0.154
Acidosis (Post treatment, n /%)	3 (8.3%)	–	0.051
P	1.000
Hypocalcemia (Prior treatment, n /%)	–	–
Hypocalcemia (Post treatment, n /%)	–	9 (90%)	<0.001
P		<0.001
Hypernatremia (Prior treatment, n /%)	–	–
Hypernatremia (Post treatment, n /%)	–	–
P
TCa/iCa > 2.5 (Prior treatment, n /%)	–	–
TCa/iCa > 2.5 (Post treatment, n /%)	–	2 (20%)	0.485
P		0.474
CA (Prior treatment, n /%)	–	–
CA (Post treatment, n /%)	–	–
P

Data availability statement

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.