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Intensive monitoring of post filter ionized calcium concentrations during CVVHD with regional citrate

Dmytro Khadzhynov1, Jonas Deissler1, Otajon Bobonov1

  • 1Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Charitéplatz 1, 10117 Berlin, Germany.

Journal of Critical Care
|April 4, 2020
PubMed

Insights

Post-filter ionized calcium (pfCa) monitoring during continuous veno-venous hemodialysis (CVVHD) with regional citrate anticoagulation (RCA) may not be necessary for predicting filter clotting. Studies show pfCa levels did not correlate with filter survival, suggesting less frequent monitoring could be safe.

Area of Science:

  • Nephrology
  • Intensive Care Medicine
  • Biomedical Engineering

Background:

  • Continuous veno-venous hemodialysis (CVVHD) is a critical care renal replacement therapy.
  • Regional citrate anticoagulation (RCA) is frequently used with CVVHD to prevent circuit clotting.
  • Monitoring post-filter ionized calcium (pfCa) is a common practice to guide RCA efficacy and safety.

Purpose of the Study:

  • To evaluate the predictive value of post-filter ionized calcium (pfCa) levels for filter clotting during CVVHD with RCA.
  • To determine if pfCa levels correlate with filter survival and the incidence of filter clotting.

Main Methods:

  • Retrospective analysis of 1070 patients treated with RCA-CVVHD over 3 years.
  • Standardized citrate starting dose of 4 mmol/L blood and a target pfCa range of 0.25-0.35 mmol/L.
  • Assessment of filter survival and correlation of last pfCa with filter clotting incidence.

Main Results:

  • A majority of patients (69.7%) achieved target pfCa levels at initiation.
  • The fraction of patients with pfCa above the target range significantly decreased within 12 hours (13.1% to 7.8%).
  • No significant difference in filter survival was observed across different initial pfCa ranges, and no significant correlation was found between the last pfCa and filter clotting.

Conclusions:

  • CVVHD with RCA and a 4 mmol/L citrate dose effectively maintains pfCa within the target range for most patients.
  • The lack of association between pfCa and filter clotting suggests that less frequent pfCa monitoring may be safe.
  • This finding could lead to optimized monitoring protocols for RCA-CVVHD, potentially reducing resource utilization.
Abstract

Keywords:
Continuous renal replacement therapyFilter clottingIonized calciumPOCTPost-filter calciumRegional citrate anticoagulation

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