A safe and effective protocol for postdilution hemofiltration with regional citrate anticoagulation

Area of Science:

• Nephrology
• Intensive Care Medicine
• Critical Care

Background:

• Regional citrate anticoagulation (RCA) is recommended for continuous renal replacement therapy (CRRT) to prolong filter lifespan.
• Existing RCA protocols are primarily designed for hemodialysis/hemodiafiltration, with fewer effective options for continuous veno-venous hemofiltration (CVVH).
• CVVH is crucial for clearing high-molecular-weight solutes, necessitating specific anticoagulation strategies.

Purpose of the Study:

• To evaluate a novel RCA protocol specifically designed for postdilution CVVH.
• To assess the safety and efficacy of this new RCA protocol in surgical patients with acute kidney injury.

Main Methods:

• A monocentric prospective interventional study involving 38 surgical patients with stage III acute kidney injury.
• Evaluation of a new RCA protocol for postdilution CVVH over 72-hour treatment sessions.
• Monitoring of filter patency, hemodynamic parameters, laboratory values, and safety endpoints (metabolic alkalosis, hypocalcemia).

Main Results:

• The mean filter lifespan was 66 ± 12 hours, with 83% of filters patent at 72 hours after censoring.
• The delivered dialysis dose averaged 28 ± 5 ml/kgBW/h, with significant reductions in creatinine, urea, and beta2-microglobulin.
• Adverse events were minimal: one case of metabolic alkalosis and four instances of low ionized calcium, with no citrate accumulation.

Conclusions:

• The developed RCA protocol is safe, effective, and user-friendly for postdilution CVVH.
• It achieves a sustained filter lifespan without significant adverse effects like metabolic alkalosis or hypocalcemia.
• This protocol facilitates the administration of adequate dialysis doses and effective clearance of molecules during CVVH.