Simplified regional citrate anticoagulation using a calcium-containing replacement solution for continuous venovenous hemofiltration

2012 ◽  
Vol 16 (2) ◽  
pp. 185-192 ◽  
Author(s):  
Ling Zhang ◽  
Yujie Liao ◽  
Jin Xiang ◽  
Wei Qin ◽  
Xiaodong Wu ◽  
...  
Keyword(s):  
Regional Citrate Anticoagulation ◽  
Continuous Venovenous Hemofiltration ◽  
Citrate Anticoagulation ◽  
Replacement Solution

scholarly journals Implementation of a Simplified Regional Citrate Anticoagulation Protocol for Post-Dilution Continuous Hemofiltration Using a Bicarbonate Buffered, Calcium Containing Replacement Solution

2016 ◽  
Vol 42 (4) ◽  
pp. 349-355 ◽  
Author(s):  
Christopher J. Kirwan ◽  
Ross Hutchison ◽  
Sherif Ghabina ◽  
Stephanie Schwarze ◽  
Abigail Beane ◽  
...  
Keyword(s):  
Metabolic Alkalosis ◽  
Calcium Supplementation ◽  
Regional Citrate Anticoagulation ◽  
Prospective Audit ◽  
Bleeding Events ◽  
Continuous Hemofiltration ◽  
Citrate Anticoagulation ◽  
Replacement Solution ◽  
Acid Citrate Dextrose ◽  
Citrate Dextrose

Background/Aims: Recent updates to the Nikkiso Aquarius continuous renal replacement therapy (CRRT) platform allowed us to develop a post-dilution protocol for regional citrate anticoagulation (RCA) using standard bicarbonate buffered, calcium containing replacement solution with acid citrate dextrose formula-A as a citrate source. Our objective was to demonstrate that the protocol was safe and effective. Methods: Prospective audit of consecutive patients receiving RCA for CRRT within intensive care unit, who were either contraindicated to heparin or had poor filter lifespan (<12 h for 2 consecutive filters) on heparin. Results: We present the first 29 patients who used 98 filters. After excluding ‘non-clot' filter loss, 50% had a duration of >27 h. Calcium supplementation was required for 30 (30%) filter circuits, in 17 of 29 (58%) patients. One patient discontinued the treatment due to metabolic alkalosis, but there were no adverse bleeding events. Conclusion: Post-dilution RCA system is effective and simple to use on the Aquarius platform and results in comparable filter life for patients relatively contraindicated to heparin.

Regional Citrate Anticoagulation Reduces Polymorphonuclear Cell Degranulation in Critically Ill Patients Treated With Continuous Venovenous Hemofiltration

2011 ◽  
Vol 15 (6) ◽  
pp. 556-564 ◽  
Author(s):  
Khajohn Tiranathanagul ◽  
Onanong Jearnsujitwimol ◽  
Paweena Susantitaphong ◽  
Narin Kijkriengkraikul ◽  
Asada Leelahavanichkul ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Regional Citrate Anticoagulation ◽  
Continuous Venovenous Hemofiltration ◽  
Polymorphonuclear Cell ◽  
Citrate Anticoagulation

scholarly journals Regional Citrate Anticoagulation versus No-Anticoagulation for Continuous Venovenous Hemofiltration in Acute Severe Hypernatremia Patients with Increased Bleeding Risk: A Retrospective Cohort Study

2019 ◽  
Vol 49 (1-2) ◽  
pp. 44-54
Author(s):  
Lijuan Zhao ◽  
Feng Ma ◽  
Yan Yu ◽  
Yangping Li ◽  
Yan Wang ◽  
...  
Keyword(s):  
Reduction Rate ◽  
Bleeding Risk ◽  
Regional Citrate Anticoagulation ◽  
Continuous Venovenous Hemofiltration ◽  
Sodium Reduction ◽  
Citrate Anticoagulation ◽  
Assessment Scores ◽  
Failure Assessment ◽  
Randomized Control ◽  
High Bleeding Risk

Purpose: This study was aimed at evaluating the efficacy and safety of regional citrate anticoagulation (RCA) versus no-anticoagulation continuous venovenous hemofiltration (CVVH) in acute severe hypernatremia patients with increased bleeding risk. Materials and Methods: Acute severe hypernatremia patients with high bleeding risk who underwent CVVH in our center between January 2011 and October 2017 were considered as candidates. Patients who were <18 years old, with hypovolemic hypernatremia, and had systemic anticoagulation were excluded. The included patients were divided into RCA and no-anticoagulation groups according to their anticoagulation strategy during CVVH and matched by age, sequential organ failure assessment scores, and vasopressor dependency. Results: Of the 64 included patients, no-anticoagulation and RCA were employed for CVVH in 23 and 41 patients, respectively. The serum sodium reduction rate (RRSeNa) was not significantly different between the no-anticoagulation and RCA groups (p = 0.729). Compared to no-anticoagulation, RCA significantly prolonged the circuit survival time (15 h [4.1–23.9] vs. 51 h [21.3–80.7], p = 0.001). The incidence of filter failure was 65.2% (15/23) in the no-anticoagulation group and 2.4% (1/41) in the RCA group (p < 0.001), respectively. In the matched cohort, the RRSeNas were not different between the 2 groups (p = 0.569), and the filter lifespan was significantly longer in the RCA group as well (p < 0.001). Conclusion: RCA might be safe and effective for acute severe hypernatremia patients who underwent CVVH treatment. Further prospective, randomized, control trials are warranted to obtain robust evidences.

A target-oriented algorithm for maintaining serum calcium stability automatically in regional citrate anticoagulation

2020 ◽  
pp. 039139882098262
Author(s):  
Ruan-Mei Sheng ◽  
Wen-Biao Zhao ◽  
Li-Hong Huang ◽  
Jian-Qin Chen ◽  
Zhen-Juan Dai ◽  
...  
Keyword(s):  
Serum Calcium ◽  
Calcium Supplementation ◽  
Calcium Supplement ◽  
Regional Citrate Anticoagulation ◽  
Trial And Error ◽  
Citrate Anticoagulation ◽  
Replacement Solution ◽  
Free Replacement ◽  
Post Filter

Background: Regional citrate anticoagulation (RCA) for renal replacement therapy is widely practiced in critically ill patients. However, concern exists regarding its labor-intensiveness for monitoring and the associated hypocalcemia. In this study, we provided an algorithm for prescribing RCA and evaluated its safety in patients. Methods: During 18 hemofiltration treatments with calcium-free replacement solution, participants were randomized to receive algorithm-based or trial-and-error RCA protocol. The effluent volume, post-filter and in vivo ionized calcium (iCa), and calcium in the sera and effluents were periodically measured at an interval of 1 to 2 h. Results: For patients received algorithm-based RCA protocol, no one had a serum iCa less than 0.9 mmol/L, and none needed calcium supplement adjustment to maintain serum calcium stability. For patients accepted trial-and-error protocol, all patients had a serum iCa below 0.9 mmol/L, their serum iCa and calcium levels fluctuated dramatically, and all patients need additional calcium supplement adjustment during RCA. None of the participants showed a post-filter iCa > 0.4 mmol/L. Conclusion: We provided a safe algorithm for calculating calcium supplementation doses that could maintain serum calcium stability without additional adjustment during RCA.

A NOVEL METHOD FOR REGIONAL CITRATE ANTICOAGULATION IN CONTINUOUS VENOVENOUS HEMOFILTRATION (CVVHF)

Renal Failure ◽  
2002 ◽  
Vol 24 (3) ◽  
pp. 325-335 ◽  
Author(s):  
R. Michael Hofmann ◽  
R.N. Christine Maloney ◽  
David M. Ward ◽  
Bryan N. Becker
Keyword(s):  
Regional Citrate Anticoagulation ◽  
Continuous Venovenous Hemofiltration ◽  
Citrate Anticoagulation ◽  
Novel Method
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