Implementation of a Simplified Regional Citrate Anticoagulation Protocol for Post-Dilution Continuous Hemofiltration...

Area of Science:

• Nephrology
• Intensive Care Medicine
• Biomedical Engineering

Background:

• Continuous renal replacement therapy (CRRT) platforms require effective anticoagulation to maintain filter lifespan.
• Heparin use is contraindicated in some intensive care unit (ICU) patients, necessitating alternative anticoagulation strategies.
• Regional citrate anticoagulation (RCA) offers a potential alternative, but requires optimized protocols for specific CRRT platforms.

Purpose of the Study:

• To develop and evaluate a post-dilution RCA protocol on the Nikkiso Aquarius CRRT platform.
• To assess the safety and efficacy of this novel RCA protocol in ICU patients.
• To determine if the protocol provides adequate filter lifespan for patients with heparin contraindications.

Main Methods:

• A prospective audit was conducted on consecutive ICU patients undergoing CRRT with the developed RCA protocol.
• Patients included were those contraindicated to heparin or with poor filter lifespan (<12 hours) on heparin.
• The protocol utilized post-dilution RCA with standard bicarbonate-buffered, calcium-containing replacement solution and acid citrate dextrose formula-A.

Main Results:

• Ninety-eight filters were used across 29 patients.
• Excluding filter loss due to 'non-clot' causes, 50% of filters achieved a duration exceeding 27 hours.
• Calcium supplementation was needed in 30% of filter circuits (58% of patients); one patient discontinued due to metabolic alkalosis, with no adverse bleeding events.

Conclusions:

• The post-dilution RCA protocol is effective and user-friendly on the Nikkiso Aquarius platform.
• This RCA protocol demonstrates comparable filter survival rates to heparin in patients with contraindications.
• The protocol represents a safe and viable anticoagulation strategy for CRRT in select ICU populations.