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Continuous venovenous haemofiltration using a citrate buffered substitution fluid.

M Schmitz1, G Taskaya, J Plum

  • 1Clinic for Nephrology, University Hospital, Düsseldorf, Germany.

Anaesthesia and Intensive Care
|November 21, 2007
PubMed
Summary

This study introduces a simple, safe citrate-based fluid for continuous renal replacement therapy, effectively managing anticoagulation and acid-base balance in critically ill patients with acute renal failure.

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Area of Science:

  • Nephrology
  • Intensive Care Medicine
  • Biochemistry

Background:

  • Regional citrate anticoagulation in continuous renal replacement therapy (CRRT) can be complex.
  • Limited data exists on long-term acid-base stability and citrate levels during CRRT.
  • Existing CRRT anticoagulation methods may not meet modern efficacy requirements.

Purpose of the Study:

  • To describe a simplified system using citrate for anticoagulation and buffering in CRRT.
  • To evaluate the efficacy and safety of citrate-based substitution fluid in predilution mode.
  • To assess acid-base and electrolyte stability during citrate-buffered CRRT.

Main Methods:

  • Utilized a citrate-containing, calcium-free substitution fluid in predilution mode for CRRT.
  • Maintained a constant ratio between blood flow (120-150 ml/min) and substitution flow (2400-3000 ml/hr).
  • Treated 20 patients with acute renal failure requiring mechanical ventilation.

Main Results:

  • Achieved stable acid-base and electrolyte balance in all patients.
  • Observed no bleeding complications, with appropriate activated clotting times.
  • Demonstrated effective filter lifespan (48.6 +/- 13.2 hours).

Conclusions:

  • Predilution with citrate-based substitution fluid offers safe and effective anticoagulation and acid-base control in CRRT for bleeding-risk patients.
  • This method is easy to apply and maintains stable patient parameters.
  • Effective CRRT clearance is achievable by maintaining a constant blood to substitution flow ratio.