Calcium supplementation in CVVH using regional citrate anticoagulation
Yin Zheng1,2, Zhongye Xu1, Qichen Fan1
1Division of Nephrology and Unit of Critical Care Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200011, China.
Hemodialysis International. International Symposium on Home Hemodialysis
|February 5, 2019
Summary
Calcium supplementation during regional citrate anticoagulation (RCA) in continuous renal replacement therapy (CRRT) is crucial. This study developed mathematical models to simplify calcium needs, improving safety and efficacy in RCA-CVVH.
Area of Science:
- Nephrology
- Critical Care Medicine
- Biochemistry
Background:
- Regional citrate anticoagulation (RCA) is vital for continuous renal replacement therapy (CRRT), but requires careful calcium management.
- Maintaining safe and effective RCA necessitates precise calcium supplementation to prevent hypocalcemia and citrate toxicity.
Purpose of the Study:
- To identify key determinants of calcium requirements during RCA with continuous veno-venous hemofiltration (CVVH).
- To develop and validate a simplified, two-phase calcium supplementation protocol using mathematical models for RCA-CVVH.
Main Methods:
- A two-phase study involving 20 patients (discovery) and 97 patients (validation) undergoing RCA-CVVH.
- Serial measurements of systemic citrate, total calcium, protein-bound calcium, and ionized calcium.
- Development of mathematical algorithms for individualized calcium infusion rates based on citrate levels and extracorporeal calcium loss.
Main Results:
- Calcium flux in the extracorporeal circuit and citrate-calcium complex formation were primary determinants of calcium needs.
- Mathematical models allowed stable maintenance of systemic calcium levels within the normal range.
- The new protocol reduced the frequency of calcium monitoring and simplified management.
Conclusions:
- Calcium supplementation in RCA-CVVH is a two-phase process influenced by citrate levels and extracorporeal circuit dynamics.
- Proposed mathematical models effectively quantify calcium needs, enabling personalized RCA prescriptions.
- This approach simplifies RCA management in the CVVH mode, enhancing patient safety and treatment efficacy.
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