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Regional citrate anticoagulation in continuous venovenous hemodiafiltration
D J Kutsogiannis1, I Mayers, W D Chin
1Division of Critical Care Medicine, the University of Alberta, Edmonton, Canada. dkutsogi@telusplanet.net
Summary
A new algorithm using posthemofilter ionized calcium levels safely guides regional citrate anticoagulation during continuous venovenous hemodiafiltration (CVVHDF), prolonging filter life and maintaining effective renal replacement therapy.
Area of Science:
- Nephrology
- Critical Care Medicine
- Biomedical Engineering
Background:
- Continuous venovenous hemodiafiltration (CVVHDF) is a key renal replacement therapy for critically ill patients.
- Regional citrate anticoagulation is effective for CVVHDF circuits, especially in high-risk bleeding patients.
- A standardized method for dosing citrate in CVVHDF is lacking.
Purpose of the Study:
- To evaluate an algorithm utilizing posthemofilter ionized calcium levels to guide regional citrate anticoagulation during CVVHDF.
- To assess the impact of this algorithm on hemofilter survival and function.
- To determine the safety of this anticoagulation management strategy.
Main Methods:
- A prospective study involving nine patients with renal failure undergoing CVVHDF.
- Implementation of an algorithm to monitor and adjust citrate infusion based on posthemofilter ionized calcium levels.
- Analysis of hemofilter survival time, urea and creatinine clearances, and bleeding complications.
Main Results:
- The median filter survival time was 3.4 days (46% survival probability).
- No significant decline in urea or creatinine clearance was observed.
- Low incidence rates of definite (0.045/person-day) and occult (0.091/person-day) bleeding complications were recorded.
Conclusions:
- Guiding regional citrate anticoagulation with posthemofilter ionized calcium levels is a safe and effective strategy.
- This method prolongs filter lifespan during CVVHDF.
- It supports optimal renal replacement therapy in critically ill patients.