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Hypertonic Citrate Solution Protocol Associated with Longer Filter Lifetime in Critically Ill Patients Requiring
Anyarin Wannakittirat1,2, Khanittha Yimsangyad2,3,4, Nuttha Lumlertgul2,3,4
1Division of Nephrology, Department of Medicine, Faculty of Medicine, Naresuan University Hospital, Phitsanulok, Thailand.
Blood Purification
|June 1, 2025
Summary
Hypertonic regional citrate anticoagulation (RCA) in continuous kidney replacement therapy (CKRT) significantly extends filter lifetime compared to isotonic RCA. This finding is crucial for optimizing CKRT protocols and improving patient outcomes.
Area of Science:
- Nephrology
- Critical Care Medicine
- Biomedical Engineering
Background:
- Regional citrate anticoagulation (RCA) is the standard for continuous kidney replacement therapy (CKRT).
- Premature circuit clotting in CKRT increases workload, costs, and adverse patient outcomes.
- Limited research exists on RCA protocols and their impact on circuit clotting during CKRT.
Purpose of the Study:
- To investigate factors influencing filter lifetime in RCA-CKRT.
- To identify causes of premature circuit clotting.
- To analyze the impact of different citrate formulas on filter longevity.
Main Methods:
- Retrospective cohort study of CKRT patients from February to September 2023.
- Primary outcome: identification of factors associated with premature circuit clotting.
- Secondary outcomes: circuit ionized calcium, citrate doses, blood transfusions, and citrate formulations.
Main Results:
- 199 filters from 97 patients were analyzed; 38 experienced premature clotting (≤72 h).
- Multivariable analysis revealed isotonic citrate formulations (RR 2.45) and corrected citrate doses (RR 0.48) significantly impacted premature clotting.
- Hypertonic RCA protocols showed a longer filter lifetime than isotonic RCA protocols.
Conclusions:
- RCA prescription influences filter lifetime and circuit integrity in CKRT.
- Hypertonic RCA is associated with significantly longer filter lifetimes compared to isotonic RCA.
- Further randomized controlled trials are necessary to validate these findings.
Keywords:
Acute kidney injuryContinuous kidney replacement therapyFilter lifetimeHypertonic citrate solutionIsotonic citrate solutionRegional citrate anticoagulationMore Related Videos
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