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Continuous venovenous hemofiltration with or without predilution regional citrate anticoagulation: a prospective
S Azam Nurmohamed1, Marc G Vervloet, Armand R J Girbes
1Department of Nephrology, VU University Medical Center, Amsterdam, The Netherlands. SA.Nurmohamed@VUMC.nl
Blood Purification
|August 19, 2007
Summary
Regional citrate anticoagulation (RCA) significantly improved filter life during continuous venovenous hemofiltration (CVVH) in high-bleeding-risk patients. This method offered better azotemic control without increasing costs or causing complications.
Area of Science:
- Nephrology
- Critical Care Medicine
- Renal Replacement Therapy
Background:
- Continuous venovenous hemofiltration (CVVH) necessitates anticoagulation to prevent circuit clotting.
- Anticoagulation poses a high bleeding risk, limiting CVVH use in certain patient populations.
- Regional citrate anticoagulation (RCA) is an alternative anticoagulation strategy.
Purpose of the Study:
- To compare the efficacy and safety of CVVH with and without RCA.
- To evaluate filter lifespan, azotemic control, and cost-effectiveness.
- To assess RCA's suitability for patients with high bleeding risk.
Main Methods:
- Prospective sequential cohort study design.
- Cohort 1: Anticoagulant-free predilution CVVH (n=31) in high-bleeding-risk patients with acute renal failure.
- Cohort 2: CVVH with regional citrate anticoagulation (n=20).
Main Results:
- Median filter life was significantly longer with RCA (41 hours) compared to anticoagulant-free CVVH (12 hours).
- Azotemic control was superior in the RCA group.
- Hourly costs were comparable between the two treatment groups.
Conclusions:
- Regional citrate anticoagulation enhances filter longevity in CVVH for high-bleeding-risk patients.
- RCA demonstrates safety, feasibility, and comparable cost-effectiveness.
- Citrate-based anticoagulation is a viable alternative for CVVH in this patient cohort.
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