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Published on: July 31, 2016
Regional citrate anticoagulation in predilution continuous venovenous hemofiltration using prismocitrate 10/2
Hoi-Ping Shum1, King-Chung Chan, Wing-Wa Yan
1Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China. shumhp@ha.org.hk
Summary
Regional citrate anticoagulation (RCA) simplifies continuous renal replacement therapy (CRRT). This study shows a straightforward RCA protocol using a commercial solution is safe and effective for acute renal failure patients, improving filter life and reducing bleeding risks.
Area of Science:
- Nephrology
- Critical Care Medicine
- Biochemistry
Background:
- Regional citrate anticoagulation (RCA) for continuous renal replacement therapy (CRRT) offers benefits like extended filter lifespan and reduced bleeding.
- The complexity of traditional RCA protocols hinders its widespread clinical adoption.
- A simplified approach is needed to facilitate broader use of RCA in CRRT.
Purpose of the Study:
- To describe and evaluate a simple predilution continuous venovenous hemofiltration (CVVH) protocol using a commercially available citrate-based replacement solution.
- To assess the feasibility, safety, and efficacy of this simplified RCA CVVH protocol in patients with acute renal failure.
Main Methods:
- A predilution CVVH protocol was implemented using Prismaflex system and Prismocitrate 10/2 solution.
- Sodium bicarbonate and calcium gluconate were infused to maintain target ionized calcium levels.
- Ten patients with acute renal failure were treated, with circuits run for up to 72 hours.
Main Results:
- The median circuit life was 50.3 hours, with no instances of filter clotting requiring premature circuit change.
- Systemic ionized calcium levels remained within the target range (0.98 mmol/L), and no hypernatremia or citrate toxicity was observed.
- One patient experienced metabolic alkalosis; overall, the protocol demonstrated safety and effectiveness.
Conclusions:
- A simple RCA CVVH protocol utilizing a commercially prepared citrate solution is a feasible and safe alternative for CRRT.
- This simplified regimen can potentially overcome the complexity barrier, promoting wider application of RCA.
- The protocol is effective for patients with acute renal failure, particularly those with body weight up to 80 kg.
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