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Regional citrate anticoagulation for PrismaFlex continuous renal replacement therapy
Lisa D Burry1, David D Tung, David Hallett
1Department of Pharmacy, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada. lburry@mtsinai.on.ca
The Annals of Pharmacotherapy
|August 20, 2009
Summary
Regional citrate anticoagulation (RCA) with acid citrate dextrose formula A (ACD-A) and calcium gluconate offers reasonable filter patency for continuous renal replacement therapy (CRRT). Close monitoring is essential to manage minor metabolic complications during CRRT.
Area of Science:
- Nephrology
- Critical Care Medicine
- Biochemistry
Background:
- Regional citrate anticoagulation (RCA) is widely used for continuous renal replacement therapy (CRRT) due to effective filter patency and reduced bleeding risk.
- However, RCA is associated with potential metabolic complications like hypocalcemia, hypernatremia, metabolic alkalosis, and citrate toxicity.
Purpose of the Study:
- To evaluate a new protocol using acid citrate dextrose formula A (ACD-A) and intravenous calcium gluconate for PrismaFlex CRRT.
- The study aimed to assess filter performance and metabolic stability in critically ill acute kidney injury patients.
Main Methods:
- A retrospective chart review was performed over one year in a university-affiliated ICU.
- Data included filter life, circuit and patient metabolic parameters, and blood product transfusions for 48 patients undergoing CRRT with citrate.
Main Results:
- Circuit clotting occurred in 24% of filters, with a mean filter life of 38.4 hours.
- Metabolic alkalosis was observed in 13.3% of patients, and mild hypocalcemia in 23%.
- No patient experienced severe hypocalcemia (ionized calcium <2.8 mg/dL).
Conclusions:
- The ACD-A and calcium gluconate protocol for PrismaFlex CRRT demonstrated adequate filter patency.
- Minor metabolic complications were noted, underscoring the need for vigilant electrolyte and acid-base monitoring during CRRT.
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