title: A novel regional citrate anticoagulation protocol for CRRT using only commercially available solutions.
abstract: OBJECTIVE
  To describe a citrate regional anticoagulation (CRA) protocol for patients with acute renal failure and contraindications to heparin who require continuous renal replacement therapy (CRRT), using only commercially available solutions, for units that do not want or cannot prepare extemporaneously made solutions.
  
  
  METHODS
  Case report and series from a medical/surgical intensive care unit of a university teaching hospital. A CRA protocol was developed by using only commercially available solutions. Five dialysis-specific clinical parameters were identified to allow simplified measurement and control.
  
  
  RESULTS
  There was a dramatic improvement of dialysis filter survival in the index patient that was seen in the subsequent patients receiving CRA. This was accompanied by excellent control of the clinical and biochemical parameters as well as nursing acceptance and ownership of the protocol.
  
  
  CONCLUSIONS
  It is possible to provide safe and effective CRA with only commercially available solutions. The protocol is applicable to most patients requiring CRRT.
authors.affiliation: Division of Nephrology, Sunnybrook & Women's College Health Science Centre, Toronto, Ontario, Canada.
authors.forename: Sheldon W
authors.initials: SW
authors.lastname: Tobe
authors.forename: Prince
authors.initials: P
authors.lastname: Aujla
authors.forename: Aziz A
authors.initials: AA
authors.lastname: Walele
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Oliver
authors.forename: David M J
authors.initials: DM
authors.lastname: Naimark
authors.forename: Nancy J
authors.initials: NJ
authors.lastname: Perkins
authors.forename: Marianne
authors.initials: M
authors.lastname: Beardsall
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D001777:Blood Coagulation / Q000187:drug effects*; D002118:Calcium / Q000097:blood; D019343:Citric Acid / Q000627:therapeutic use*; D002985:Clinical Protocols; D005260:Female; D005947:Glucose / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D017583:Hemodiafiltration / Q000379:methods; D015312:Hemodialysis Solutions / Q000008:administration & dosage*; D006493:Heparin / Q000627:therapeutic use; D017052:Hospital Mortality; D006784:Hospitals, Teaching; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D051437:Renal Insufficiency / Q000628:therapy
chemical_list: D000925:Anticoagulants; D015312:Hemodialysis Solutions; C002113:acid citrate dextrose; D019343:Citric Acid; D006493:Heparin; D005947:Glucose; D002118:Calcium