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A Semi-Automated and Reproducible Biological-Based Method to Quantify Calcium Deposition In Vitro
Published on: June 2, 2022
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Regional citrate anticoagulation algorithm and management protocol aimed at ensuring blood calcium stability: a
Ruanmei Sheng1, Yimeng Liu1, Shaolin Li2
1Department of Emergency and Critical Disease, Songjiang Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Clinical Kidney Journal
|August 13, 2025
Summary
A new regional citrate anticoagulation (RCA) algorithm for continuous renal replacement therapy (CRRT) significantly reduced citrate and calcium abnormalities, minimizing the need for intervention during RCA. This enhances patient safety and treatment efficiency.
Area of Science:
- Nephrology
- Critical Care Medicine
- Biomedical Engineering
Background:
- Limited clinical data exist for regional citrate anticoagulation (RCA) algorithms.
- A novel RCA algorithm has been developed for extensive continuous renal replacement therapy (CRRT) settings.
- The safety and effectiveness of RCA require further clinical validation.
Purpose of the Study:
- To evaluate the incidence of calcium and citrate abnormalities requiring intervention with a new RCA algorithm during CRRT.
- To identify optimal coefficient values (kcit and kdis) for the RCA algorithm.
- To assess the safety and efficacy of the novel RCA algorithm in diverse CRRT scenarios.
Main Methods:
- A prospective, single-arm study was conducted.
- Patients undergoing RCA with various CRRT modes and calcium-containing replacement fluids were included.
- Primary outcome: incidence of citrate and calcium overdose/deficiency without intervention. Secondary outcomes: kdis, kcit values, and blood calcium level variations.
Main Results:
- 282 RCA sessions in 110 patients were analyzed.
- Citrate and calcium abnormalities occurred in 19.5% of sessions.
- Citrate deficiency was more common in low-dose sessions (22.3%), while overdose occurred in 13.4% of high-dose sessions. Calcium overdose occurred once; no deficiency was observed.
Conclusions:
- The novel RCA algorithm reduced citrate and calcium abnormalities in CRRT.
- This algorithm minimized the need for manual adjustments to calcium and citrate supplementation.
- The findings support the use of this innovative RCA algorithm for improved CRRT management.
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