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Published on: July 19, 2011
Protocolized Regional Citrate Anticoagulation during Continuous Renal Replacement Therapy: A Single Center Experience
Anant V Pachisia1, G Praveen Kumar2, Rahul Harne1
1Institute of Critical Care and Anesthesia, Medanta - The Medicity, Gurugram, Haryana, India.
Summary
Regional citrate anticoagulation (RCA) offers a safe method for continuous renal replacement therapy (CRRT), reducing bleeding and filter clotting risks. This study evaluated a new RCA protocol, finding it effective in critically ill patients.
Area of Science:
- Nephrology
- Critical Care Medicine
- Cardiovascular System
Background:
- Regional citrate anticoagulation (RCA) is increasingly used in continuous renal replacement therapy (CRRT) to minimize bleeding and filter clotting.
- A working protocol for RCA during CRRT was developed based on existing literature and initial clinical experience.
Purpose of the Study:
- To evaluate the efficacy and safety of a standardized RCA protocol for routine use in CRRT.
- To assess the impact of the RCA protocol on filter lifespan and anticoagulation effectiveness.
Main Methods:
- A single-center, prospective, observational study involving 159 adult patients requiring CRRT.
- Patients received continuous venovenous hemodiafiltration (CVVHDF) using Prisma Flex machines with an AN 69 dialyzer.
- A protocolized RCA management strategy was implemented, targeting a CRRT dose of 25-30 mL/kg/hour.
Main Results:
- The median filter life was 30 hours, with filter clotting occurring in 33.3% of patients.
- Citrate accumulation was observed in 52.25% of patients but was manageable without CRRT discontinuation or toxicity.
- Increased citrate accumulation was significantly associated with chronic liver disease and post-living donor liver transplant status, as well as higher baseline lactate levels.
Conclusions:
- The developed RCA protocol is a safe and effective approach for anticoagulation in critically ill patients undergoing CRRT.
- The protocol allows for successful management of citrate accumulation, preventing treatment interruption.
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