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Related Experiment Videos

Simplified citrate anticoagulation for continuous renal replacement therapy.

A J Tolwani1, R C Campbell, M B Schenk

  • 1Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Alabama 35294-0007, USA. atolwani@nrtc.dom.uab.edu

Kidney International
|June 26, 2001
PubMed
Summary
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This study presents a simplified regional anticoagulation protocol for continuous renal replacement therapy (CRRT) using trisodium citrate. The new method avoids metabolic complications and bleeding, proving effective for CRRT patients needing anticoagulation alternatives.

Area of Science:

  • Nephrology
  • Critical Care Medicine
  • Biochemistry

Background:

  • Regional anticoagulation with trisodium citrate is an alternative for continuous renal replacement therapy (CRRT) in patients with heparin contraindications.
  • Metabolic complications and specialized solutions complicate standard citrate anticoagulation.
  • A simplified CRRT protocol for citrate regional anticoagulation was developed.

Purpose of the Study:

  • To evaluate the safety and efficacy of a simplified trisodium citrate regional anticoagulation protocol for CRRT.
  • To assess dialyzer clotting, bleeding complications, citrate toxicity, and patient mortality.
  • To compare the simplified protocol with previous methods.

Main Methods:

  • A 2% trisodium citrate infusion was administered prefilter at 250 mL/h, adjusted to maintain postfilter ionized calcium <0.5 mmol/L.

Related Experiment Videos

  • Systemic ionized calcium was maintained at 1.1 mmol/L using central calcium gluconate.
  • A standard dialysate and retrospective review of 29 patients were utilized.

    • Main Results:

    • Dialyzer survival was 61% at 48 hours.
    • No significant bleeding or citrate toxicity occurred.
    • Seventy-two percent of patient deaths were unrelated to CRRT.

    Conclusions:

    • The simplified CRRT protocol using regional 2% trisodium citrate is safe.
    • This protocol avoids significant bleeding complications and citrate toxicity.
    • It offers a simplified approach compared to prior 4% trisodium citrate protocols.