Net buffer load during regional citrate anticoagulated continuous renal replacement therapy.

Area of Science:

• Nephrology
• Intensive Care Medicine
• Biomedical Engineering

Background:

• Continuous renal replacement therapy (CRRT) with regional citrate anticoagulation is standard for critically ill acute kidney injury patients.
• Citrate accumulation or bicarbonate administration can lead to metabolic alkalosis.
• Net buffer load is a safety parameter in Prismax v3 software to predict metabolic alkalosis risk.

Purpose of the Study:

• To develop and evaluate algorithms for estimating net buffer load in CRRT.
• To assess the relationship between net buffer load and acid-base status.
• To compare net buffer load calculations with historical data.

Main Methods:

• Algorithms for net buffer load estimation were developed.
• Hourly clinical data from 60 CRRT patients were used for simulation.
• Net buffer load was compared to steady-state acid-base status and previous studies.

Main Results:

• Mean net buffer load was +0.09 ±0.04 mmol/h/kg, comparable to historical data.
• No significant correlation was found between net buffer load and steady-state arterial bicarbonate.
• Citrate-containing replacement fluid flow rate before the blood pump most significantly impacted net buffer load (r²=0.65, p<0.001).

Conclusions:

• The net buffer load parameter effectively alerts operators to the dialysis circuit's potential impact on acid-base status.
• Realistic net buffer load values were successfully calculated for 60 CRRT treatments.