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.

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.

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 Anticoagulant effects of different calcium supplementation pathways in calcium-free RCA-CVVH: a study protocol for a prospective randomized cross-over trial

2019 ◽  
Author(s):  
Biantong JIANG ◽  
Zhigang ZHANG ◽  
Xiu JIN ◽  
Haiye WANG ◽  
Yuchen WU ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
Calcium Ions ◽  
Calcium Supplementation ◽  
Incidence Rates ◽  
Regional Citrate Anticoagulation ◽  
Citrate Anticoagulation ◽  
Catheter Dysfunction ◽  
Calcium Effect ◽  
The Difference ◽  
Key Aspects

Abstract Background When regional citrate anticoagulation used in continuous renal replacement therapy, one of the key aspects to achieve safe and effective extracorporeal circulation is the management of calcium ions. For calcium-free RCA-CVVH, the anticoagulant effects of different calcium supplementation pathways have not yet been explored. In this trial, we would test our hypothesis that compared with the SCV, when calcium was infused through the VL-FV, the arterial iCa2+ was lower. Methods This is a prospective randomized cross-over trial involving 24 patients undergoing RCA-CVVH. The patients were randomly divided into two groups: VL-FV—SCV group and SCV—VL-FV group. The difference of iCa2+ between arterial iCa2+ and post-filtration iCa2+ was compared. Secondary indicators included the incidence rates of catheter dysfunction and hypocalcemia. Discussion This is the first trial on the anticoagulant effects of calcium-free RCA-CVVH through different calcium supplement routes. We will confirm that the arterial iCa2 + level is slightly lower when calcium is infused in the VL-FV than in the SCV, and the incidence rates of catheter dysfunction and hypocalcemia will help us to determine which site is safer. Trial Registration CHiCTR registry: ChiCTR1800020046. Registered on 12 December 2018. (http://www.chictr.org.cn/listbycreater.aspx). Keywords: Continuous venous-venous hemofiltration, regional citrate anticoagulation, calcium, effect, safety, cross-over trial

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.

Optimized Calcium Supplementation Approach for Regional Citrate Anticoagulation

Nephron ◽  
2018 ◽  
Vol 141 (2) ◽  
pp. 119-127 ◽  
Author(s):  
Wenyan Yu ◽  
Feng Zhuang ◽  
Shuai Ma ◽  
Qichen Fan ◽  
Mingli Zhu ◽  
...  
Keyword(s):  
Calcium Supplementation ◽  
Regional Citrate Anticoagulation ◽  
Citrate Anticoagulation

scholarly journals A Rare Case of Severe Metabolic Alkalosis with Unusual Hyperproteinemia Treated with Continuous Renal Replacement Therapy and Regional Citrate Anticoagulation

2018 ◽  
Vol 8 (2) ◽  
pp. 138-146 ◽  
Author(s):  
Vojtěch Matoušek ◽  
Ivan Herold ◽  
Lenka Holanová ◽  
Martin Balík
Keyword(s):  
Metabolic Alkalosis ◽  
District Hospital ◽  
Kidney Injury ◽  
Regional Citrate Anticoagulation ◽  
Severe Metabolic Acidosis ◽  
Citrate Anticoagulation ◽  
Tertiary Centre ◽  
Ethylene Glycol Poisoning ◽  
Total Plasma Protein ◽  
Continuous Haemodiafiltration

A 23-year-old woman was referred to the tertiary centre with acute kidney injury and severe metabolic alkalosis following an accidental ethylene glycol poisoning. The patient had been treated with continuous haemodiafiltration and regional citrate anticoagulation, and a tracheostomy was performed due to pneumonia. Besides severe metabolic alkalosis and hypernatremia, the laboratory tests revealed total protein of 108 g/L on admission to the tertiary centre. The haemodiafiltration with regional citrate anticoagulation continued with parallel correction of the alkalosis and normalisation of the total plasma protein. The tracheostomy was decannulated and the patient was discharged to the district hospital. The case demonstrates the usefulness of regional citrate anticoagulation even in severe metabolic alkalosis which was likely related to the method setting prior to admission and to an overcompensation of the initial severe metabolic acidosis. The unusual hyperproteinaemia might be interpreted with the aid of the Stewart-Fencl model of the acid-base regulation.

scholarly journals Regional citrate anticoagulation with a substitute containing calcium for continuous hemofiltration in children

Medicine ◽  
2019 ◽  
Vol 98 (40) ◽  
pp. e17421
Author(s):  
Ke Bai ◽  
Chengjun Liu ◽  
Fang Zhou ◽  
Feng Xu ◽  
Hongxing Dang
Keyword(s):  
Regional Citrate Anticoagulation ◽  
Continuous Hemofiltration ◽  
Citrate Anticoagulation
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