Citrate anticoagulation during CVVH in high risk bleeding patients

Area of Science:

• Nephrology
• Intensive Care Medicine
• Critical Care

Background:

• Regional citrate anticoagulation (RCA) is an effective alternative to heparin for continuous renal replacement therapy (CRRT) in patients with bleeding risks.
• Previous limitations of RCA included specialized solutions and complex metabolic monitoring.
• This study addresses these limitations by exploring a simplified RCA protocol.

Purpose of the Study:

• To evaluate the safety and feasibility of a regional citrate anticoagulation (RCA) protocol for continuous veno-venous hemofiltration (CVVH).
• To utilize commercially available replacement fluids for RCA in CVVH.
• To establish a practical RCA method for intensive care unit (ICU) settings.

Main Methods:

• Eleven high-risk bleeding patients requiring CVVH were included.
• RCA was performed using standard replacement fluids, with citrate infusion adjusted based on blood flow rates.
• Ionized calcium levels were monitored, and calcium gluconate was administered as needed to maintain systemic levels.

Main Results:

• A total of 29 filters were used over 965.5 hours, with an average filter life of 33.6 hours.
• Asymptomatic hypocalcemia occurred in 6.9% of samples; no values dropped below 0.9 mmol/L.
• Metabolic disturbances like hypernatremia and alkalosis were infrequent (9.3% and 9.4%), and no citrate toxicity was observed.

Conclusions:

• A novel protocol for RCA during CVVH using commercially available fluids was successfully developed.
• The method proved to be safe, flexible, and applicable in an ICU environment.
• This simplified RCA approach enhances CRRT management for patients with contraindications to heparin.