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Published on: April 1, 2011
Regional citrate anticoagulation and influence of recirculation on ionized calcium levels in the circuit
Anais Degraeve1, Etienne Danse2, Pierre-François Laterre1
1Department of Intensive Care, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, 1200, Brussels, Belgium.
Insights
Regional citrate anticoagulation in continuous renal replacement therapy (CRRT) can fail due to deep vein thrombosis near the catheter. This caused local citrate overload without systemic effects, necessitating a catheter site change.
Area of Science:
- Nephrology
- Intensive Care Medicine
- Clinical Biochemistry
Background:
- Regional citrate anticoagulation (RCA) is a common method for anticoagulation during continuous renal replacement therapy (CRRT), particularly in patients with bleeding risks.
- Close monitoring of RCA is crucial to prevent citrate overload, which can lead to metabolic alkalosis or acidosis.
Abstract:
Regional citrate anticoagulation is now widely used during continuous renal replacement therapy (CRRT), and especially in patients at risk for hemorrhagic complications. A close monitoring is required to avoid citrate overload, leading to metabolic alkalosis or citrate intoxication causing metabolic acidosis. This case report describes a dysfunction of the regional citrate anticoagulation due to the development of a deep vein thrombosis close to the site of insertion of the venous CRRT catheter. The result was a local recirculation in the circuit with a local citrate overload (acidosis and non-measurable calcium). In the patient's blood samples, the [calciumtotal/Ca2+systemic] ratio remained normal as a proof of local citrate accumulation without systemic effects. Initially, CRRT remained effective, but due to the progressive decrease of serum creatinine and cystatin C clearance, the site of catheter insertion was changed.
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