scholarly journals Comparison of the efficacy and safety of two regional citrate anticoagulation protocols using acid citrate dextrose A or Prismocitrate 10/2, in patients with acute renal failure undergoing continuous venovenous haemodiafiltration

Critical Care ◽  
2010 ◽  
Vol 14 (Suppl 1) ◽  
pp. P515 ◽  
Author(s):  
EL Ooi ◽  
TW Lim ◽  
N Lim
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Regional Citrate Anticoagulation ◽  
Efficacy And Safety ◽  
Citrate Anticoagulation ◽  
Acid Citrate Dextrose ◽  
Citrate Dextrose

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.

scholarly journals Ionic Homeostasis, Acid-base Balance and the Risk of Citrate Accumulation in Patients After Cardiovascular Surgery Treated With Continuous Veno-venous Haemofiltration With Post-dilution Regional Citrate Anticoagulation

2020 ◽  
Author(s):  
Agnieszka Kośka ◽  
Maciej Michał Kowalik ◽  
Anna Lango-Maziarz ◽  
Wojtek Karolak ◽  
Dariusz Jagielak ◽  
...  
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Cardiovascular Surgery ◽  
Lactate Concentration ◽  
Ionized Calcium ◽  
Regional Citrate Anticoagulation ◽  
Acid Base ◽  
Citrate Anticoagulation ◽  
Citrate Accumulation ◽  
New Onset

Abstract Background: Patients with known or new-onset acute renal failure after cardiovascular surgery, requiring renal replacement therapy, can benefit from adequate non-heparin circuit anticoagulation. The idea behind not using heparin relates to the post-operative risk of bleeding. Simplified regional citrate anticoagulation (RCA) protocol proposes the use of citric acid dextrose formula A (ACD-A) during post-dilutional continuous veno-venous hemofiltration (CVVH) with standard bicarbonate buffered calcium containing replacement solution. Citrate accumulation diagnosed upon total to ionized calcium ratio (tCa/iCa) and low ionized calcium (iCa) are considered as the biggest risks related to regional citrate accumulation.Methods: This prospective observational study evaluated electrolyte and acid-base homeostasis in cardiovascular surgery patients with known chronic or new-onset acute renal failure treated with post-dilution continuous veno-venous haemofiltration (CVVH) with a simplified RCA protocol with ACD-A. In total, 50 consecutive cardiovascular surgery patients treated with CVVH with RCA were evaluated. Base excess; pH; bicarbonate, lactate, Na+, Cl-, Mg++, and inorganic phosphate concentrations; the total to ionized calcium ratio (tCa/iCa); and high anion gap metabolic acidosis were assessed during haemofiltration treatment in survivors and non-survivors.Results: Thirty-three (66%) patients died. In total, 235 haemofiltration sessions with a median circuit survival time of 57 hours (1-117) were evaluated. The therapies were very well balanced with regard to sodium and chloride homeostasis. The lactate concentration and anion gap decreased during CVVH sessions longer than 72 hours, but no inter-group difference was observed. The tCa/iCa ratio exceeded 2.5 in 11 of 246 (4.5%) readings and was significantly higher in non-survivors (p=0.037). No correlation was observed between the lactate concentration before haemofiltration and the tCa/iCa ratio during haemofiltration. Magnesium and phosphate concentrations decreased during CVVH, and additional supplementation with magnesium was necessary. The magnesium concentration was lower in the non-survivors.Conclusions: The CVVH RCA protocol provides stable sodium and chloride concentrations and a tendency towards higher pH values and bicarbonate concentrations. Supplementation with magnesium and phosphate ions is needed. The incidence of citrate accumulation exceeded 4% and was significantly higher in non-survivors.Trial registration: retrospectively registered: Clinicaltrials.gov, NCT03836742.

Continuous venovenous hemodiafiltration (CWHDF) with citrate anticoagulation in the treatment of a patient with acute renal failure, hypercalcemia, and thrombocytopenia

1998 ◽  
Vol 24 (3) ◽  
pp. 262-264 ◽  
Author(s):  
V. Šrámek ◽  
I. Novák ◽  
M. Matějovič ◽  
R. Rokyta ◽  
M. Nalos ◽  
...  
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Citrate Anticoagulation ◽  
Continuous Venovenous Hemodiafiltration

scholarly journals Minimizing hemorrhagic complications in dialysis patients.

1991 ◽  
Vol 2 (5) ◽  
pp. 961-975 ◽  
Author(s):  
J W Lohr ◽  
S J Schwab
Keyword(s):  
Renal Failure ◽  
Bleeding Risk ◽  
Bleeding Complications ◽  
Regional Citrate Anticoagulation ◽  
Dialysis Patients ◽  
Citrate Anticoagulation ◽  
Risk Of Bleeding ◽  
Alternative Means ◽  
Clinical Strategy ◽  
Biochemical Abnormalities

Renal failure is associated with an increased incidence of hemorrhage from a variety of sites, particularly in patients undergoing surgical procedures. The primary factors in the pathogenesis of bleeding in renal failure are platelet biochemical abnormalities and alterations in platelet vessel wall interactions. Hemodialysis improves hemostatic abnormalities in uremia, but the need for heparinization during the procedure may increase the bleeding risk. The risk of bleeding may be minimized by using peritoneal dialysis or alternative means to routine heparinization to prevent clotting in the extracorporeal circulation during hemodialysis. These include use of minimal heparin, prostacyclin, regional citrate anticoagulation, and no anticoagulation. Continuous arteriovenous hemodialysis may also be performed with regional citrate anticoagulation. There are several nondialytic therapies that may be used to prevent or treat hemorrhage in renal failure patients. These include administration of cryoprecipitate, 1-deamino-8-arginine vasopressin, estrogens, red blood cells, and erythropoietin. A clinical strategy to minimize bleeding complications in dialysis patients is presented.

Adoptive Immunotherapy for B-cell Malignancies Using CD19- Targeted Chimeric Antigen Receptor T-Cells: A Systematic Review of Efficacy and Safety

2019 ◽  
Vol 26 (17) ◽  
pp. 3068-3079 ◽  
Author(s):  
Lu Hao ◽  
Tongtong Li ◽  
Lung-Ji Chang ◽  
Xiaochuan Chen
Keyword(s):  
Renal Failure ◽  
T Cells ◽  
Acute Renal Failure ◽  
Complete Remission ◽  
Adverse Effects ◽  
B Cell ◽  
Meta Analysis ◽  
Efficacy And Safety ◽  
B Cell Malignancies ◽  
Car T

Background:Adoptive infusion of chimeric antigen receptor transduced T- cells (CAR-T) is a powerful tool of immunotherapy for hematological malignancies, as evidenced by recently published and unpublished clinical results.Objective:In this report, we performed a meta-analysis to evaluate the efficacy and side effects of CAR-T on refractory and/or relapsed B-cell malignancies, including leukemia and lymphoma.Methods:Clinical studies investigating efficacy and safety of CAR-T in acute and chronic lymphocytic leukemia and lymphoma were identified by searching PubMed and EMBASE. Outcomes of efficacy subjected to analysis were the rates of complete remission (CR) and partial remission (PR). The safety parameters were the prevalence of adverse effects including fever, hypotension, and acute renal failure. Meta analyses were performed using R software. Weighted hazard ratio (HR) with 95% confidence intervals was calculated for each outcome. Fixed or random-effects models were employed depending on the heterogeneity across the included studies.Results:Nineteen published clinical studies with a total of 391 patients were included for the meta-analysis. The pooled rate of complete remission was 55% (95% CI 41%-69%); the pooled rate of partial remission was 25% (95% CI: 19%-33%). The prevalence of fever was 62% (95% CI: 41%-79%), the hypotension was 22% (95% CI: 15%-31%), and the acute renal failure was 24% (95% CI: 16%-34%). All adverse effects were manageable and no death was reported due to toxicity.Conclusion:CD19-targeted CAR-T is an effective modality in treating refractory B-cell malignancies including leukemia and lymphoma. However, there is still a need to develop strategies to improve the safety in its clinical use.

scholarly journals Comparison between regional citrate anticoagulation and heparin for intermittent hemodialysis in ICU patients: a propensity score-matched cohort study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Christophe Leroy ◽  
Bruno Pereira ◽  
Edouard Soum ◽  
Claire Bachelier ◽  
Elisabeth Coupez ◽  
...  
Keyword(s):  
Propensity Score ◽  
Regional Citrate Anticoagulation ◽  
Intermittent Hemodialysis ◽  
Efficacy And Safety ◽  
Icu Patients ◽  
Citrate Anticoagulation ◽  
Increased Risk ◽  
Heparin Anticoagulation ◽  
Calcium Infusion

Abstract Background Regional citrate anticoagulation (RCA) is the gold standard of anticoagulation for continuous renal replacement therapy but is rarely used for intermittent hemodialysis (IHD) in ICU. Few studies assessed the safety and efficacy of RCA during IHD in ICU; however, no data are available comparing RCA to heparin anticoagulation, which are commonly used for IHD. The aim of this study was to assess the efficacy and safety of RCA compared to heparin anticoagulation during IHD. Methods This retrospective single-center cohort study included consecutive ICU patients treated with either heparin anticoagulation (unfractionated or low-molecular-weight heparin) or RCA for IHD from July to September in 2015 and 2017. RCA was performed with citrate infusion according to blood flow and calcium infusion by diffusive influx from dialysate. Using a propensity score analysis, as the primary endpoint we assessed whether RCA improved efficacy, quantified with Kt/V from the ionic dialysance, compared to heparin anticoagulation. The secondary endpoint was safety. Exploratory analyses were performed on the changes in efficacy and safety between the implementation period (2015) and at long term (2017). Results In total, 208 IHD sessions were performed in 56 patients and were compared (124 RCA and 84 heparin coagulation). There was no difference in Kt/V between RCA and heparin (0.95 ± 0.38 vs. 0.89 ± 0.32; p = 0.98). A higher number of circuit clotting (12.9% vs. 2.4%; p = 0.02) and premature interruption resulting from acute high transmembrane pressure (21% vs. 7%; p = 0.02) occurred in the RCA sessions compared to the heparin sessions. In the propensity score-matching analysis, RCA was associated with an increased risk of circuit clotting (absolute differences = 0.10, 95% CI [0.03–0.18]; p = 0.008). There was no difference in efficacy and safety between the two time periods (2015 and 2017). Conclusion RCA with calcium infusion by diffusive influx from dialysate for IHD was easy to implement with stable long-term efficacy and safety but did not improve efficacy and could be associated with an increased risk of circuit clotting compared to heparin anticoagulation in non-selected ICU patients. Randomized trials to determine the best anticoagulation for IHD in ICU patients should be conducted in a variety of settings.

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