scholarly journals Regional citrate anticoagulation for renal replacement therapies in patients with acute kidney injury: a position statement of the Work Group “Renal Replacement Therapies in Critically Ill Patients” of the Italian Society of Nephrology

2015 ◽  
Vol 28 (2) ◽  
pp. 151-164 ◽  
Author(s):  
Enrico Fiaccadori ◽  
Valentina Pistolesi ◽  
Filippo Mariano ◽  
Elena Mancini ◽  
Giorgio Canepari ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Work Group ◽  
Kidney Injury ◽  
Position Statement ◽  
Italian Society ◽  
Regional Citrate Anticoagulation ◽  
Citrate Anticoagulation ◽  
Renal Replacement Therapies

Hypophosphatemia in critically ill patients with acute kidney injury on renal replacement therapies

2019 ◽  
Vol 32 (6) ◽  
pp. 895-908 ◽  
Author(s):  
Valentina Pistolesi ◽  
Laura Zeppilli ◽  
Enrico Fiaccadori ◽  
Giuseppe Regolisti ◽  
Luigi Tritapepe ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Kidney Injury ◽  
Renal Replacement Therapies

scholarly journals Low bicarbonate replacement fluid normalizes metabolic alkalosis during continuous veno-venous hemofiltration with regional citrate anticoagulation

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Paul Köglberger ◽  
Sebastian J. Klein ◽  
Georg Franz Lehner ◽  
Romuald Bellmann ◽  
Andreas Peer ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Metabolic Alkalosis ◽  
Base Excess ◽  
Kidney Injury ◽  
Regional Citrate Anticoagulation ◽  
Citrate Anticoagulation ◽  
Future Studies ◽  
Replacement Fluid ◽  
Retrospective Comparative Study

Abstract Background Metabolic alkalosis is a frequently occurring problem during continuous veno-venous hemofiltration (CVVH) with regional citrate anticoagulation (RCA). This study aimed to evaluate the effectiveness of switching from high to low bicarbonate (HCO3−) replacement fluid in alkalotic critically ill patients with acute kidney injury treated by CVVH and RCA. Methods A retrospective-comparative study design was applied. Patients who underwent CVVH with RCA in the ICU between 09/2016 and 11/2017 were evaluated. Data were available from the clinical routine. A switch of the replacement fluid Phoxilium® (30 mmol/l HCO3−) to Biphozyl® (22 mmol/l HCO3−) was performed as blood HCO3− concentration persisted ≥ 26 mmol/l despite adjustments of citrate dose and blood flow. Data were collected from 72 h before the switch of the replacement solutions until 72 h afterwards. Results Of 153 patients treated with CVVH during that period, 45 patients were switched from Phoxilium® to Biphozyl®. Forty-two patients (42 circuits) were available for statistical analysis. After switching the replacement fluid from Phoxilium® to Biphozyl® the serum HCO3− concentration decreased significantly from 27.7 mmol/l (IQR 26.9–28.9) to 25.8 mmol/l (IQR 24.6–27.7) within 24 h (p < 0.001). Base excess (BE) decreased significantly from 4.0 mmol/l (IQR 3.1–5.1) to 1.8 mmol/l (IQR 0.2–3.4) within 24 h (p < 0.001). HCO3− and BE concentration remained stable from 24 h till the end of observation at 72 h after the replacement fluid change (p = 0.225). pH and PaCO2 did not change significantly after the switch of the replacement fluid until 72 h. Conclusions This retrospective analysis suggests that for patients developing refractory metabolic alkalosis during CVVH with RCA the use of Biphozyl® reduces external HCO3− load and sustainably corrects intracorporeal HCO3− and BE concentrations. Future studies have to prove whether correcting metabolic alkalosis during CVVH with RCA in critically ill patients is of relevance in terms of clinical outcome.

scholarly journals Regional citrate versus systemic heparin anticoagulation for continuous renal replacement therapy in critically ill patients with acute kidney injury (RICH) trial: study protocol for a multicentre, randomised controlled trial

BMJ Open ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. e024411 ◽  
Author(s):  
Melanie Meersch ◽  
Mira Küllmar ◽  
Carola Wempe ◽  
Detlef Kindgen-Milles ◽  
Stefan Kluge ◽  
...  
Keyword(s):  
Overall Survival ◽  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Critically Ill Patients ◽  
Kidney Injury ◽  
Ethics Committee ◽  
Regional Citrate Anticoagulation ◽  
Citrate Anticoagulation ◽  
Heparin Anticoagulation

IntroductionAcute kidney injury (AKI) is a well-recognised complication of critical illness which is of crucial importance for morbidity, mortality and health resource utilisation. Renal replacement therapy (RRT) inevitably entails an escalation of treatment complexity and increases costs for those patients with severe AKI. However, it is still not clear whether regional citrate anticoagulation or systemic heparin anticoagulation for continuous RRT (CRRT) is most appropriate. We hypothesise that, in contrast to systemic heparin anticoagulation, regional citrate anticoagulation for CRRT prolongs filter life span and improves overall survival in a 90-day follow-up period (coprimary endpoints).Methods and analysisWe will conduct a prospective, randomised, multicentre, clinical trial including up to 1450 critically ill patients with AKI requiring CRRT. We suggest to investigate the effect of regional citrate anticoagulation for CRRT as compared with systemic heparin anticoagulation. The two coprimary outcomes are filter life span and overall survival in a 90-day follow-up period. Secondary outcomes are length of stay in the intensive care unit; length of hospitalisation; duration of CRRT; recovery of renal function at days 28, 60, 90 and 1 year; requirement for RRT after days 28, 60, 90 and 1 year; 28 days, 60 days, 90 days and 1-year all-cause mortality; major adverse kidney events at days 28, 60, 90 and 1 year; bleeding complications; transfusion requirements; infection rate and costs of RRT. Additionally, in an add-on study involving several of the participating centres, blood samples from recruited patients will be collected at different time points to analyse whether the anticoagulation strategy has an impact on immune response as evidenced by leucocyte recruitment and function.Ethics and disseminationThe RICH trial has been approved by the Federal Institute for Drugs and Medical Devices, the leading Ethics Committee of the University of Münster and the corresponding Ethics Committee at each participating site.Trial registration numberNCT02669589.

Hyperlactatemia Predicts Citrate Intolerance With Regional Citrate Anticoagulation During Continuous Renal Replacement Therapy

2017 ◽  
Vol 34 (5) ◽  
pp. 418-425 ◽  
Author(s):  
Jia-Neng Tan ◽  
Sabrina Wong Peixin Haroon ◽  
Amartya Mukhopadhyay ◽  
Titus Lau ◽  
Tanusya M. Murali ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Characteristic Curve ◽  
Kidney Injury ◽  
Serum Lactate ◽  
Organic Substrate ◽  
Regional Citrate Anticoagulation ◽  
Citrate Anticoagulation ◽  
Peak Lactate ◽  
Lactate Levels

Purpose: We aim to determine whether hyperlactatemia, which suggests multi-organ dysfunction and impaired organic substrate metabolism, may predict intolerance to regional citrate anticoagulation (RCA) during continuous venovenous hemofiltration (CVVH). Methods: We performed a single-center, retrospective observational study in critically ill patients with acute kidney injury or end-stage renal disease and evaluated the association of peak serum lactate levels with citrate intolerance (CI) during the initial 72 hours of RCA-CVVH, defined by serum total-to-ionized calcium >2.5 plus systemic hypocalcemia. Results: Eighty-eight patients were studied (aged 59 ± 14 years, 66% males, Acute Physiology and Chronic Health Evaluation II: 31 ± 8). Citrate was dosed at median 2.1 mmol/L of blood flow, with citrate load of 30 mmol/h, and CVVH effluent of 43 mL/kg/h. Twenty patients developed CI. Comparing patients with CI versus none, peak lactate levels were 8 (5-11) versus 3 (2-6) mmol/L, calcium replacement was 13 (10-17) versus 11 (8-12) mmol/h, and standard base excess was −4 (−12 to 1) versus 2(−4 to 7) mmol/L, respectively ( P < .05). Citrate intolerance developed in 38%, 44%, and 55%, in patients with peak lactate >4, >6, >7 mmol/L, respectively, versus 7% in those with peak lactate ≤4 mmol/L ( P ≤ .001), despite comparable citrate load and effluent rates across all categories. On multivariate analysis, hyperlactatemia and hyperbilirubinemia predicted CI ( P ≤ .01), which was associated with increasing calcium infusion requirement. Higher peak lactate from >4 to >7 mmol/L predicted CI with graded increase in odds ratio and specificity from 59% to 87%, but the corresponding negative predictive value from 93% to 87%. Area under nonparametric receiver operating characteristic curve for peak lactate and CI was 0.78. Conclusion: Hyperlactatemia predicts CI during RCA-CVVH with reasonable discriminatory performance in critically ill patients. Serum lactate surveillance may help preempt issues with citrate toxicity.

Use of regional citrate anticoagulation for continuous venovenous hemodialysis in critically ill cancer patients with acute kidney injury

2018 ◽  
Vol 47 ◽  
pp. 302-309 ◽  
Author(s):  
Verônica Torres Costa e Silva ◽  
Renato Antunes Caires ◽  
Juliana Silva Bezerra ◽  
Elerson C. Costalonga ◽  
Ana Paula Leandro Oliveira ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cancer Patients ◽  
Critically Ill ◽  
Kidney Injury ◽  
Regional Citrate Anticoagulation ◽  
Citrate Anticoagulation ◽  
Continuous Venovenous Hemodialysis
Sign in / Sign up

Export Citation Format

Share Document