Regional citrate anticoagulation in critically ill patients treated with plasma filtration and adsorption.
BACKGROUND
In high-risk bleeding conditions conventional systemic anticoagulation with heparin is a contraindication to renal replacement therapy. We evaluate the feasibility and safety of regional citrate anticoagulation in high-risk bleeding conditions during coupled plasma filtration adsorption (CPFA).


METHODS
Thirteen critically ill patients (9 severely burned, 4 polytraumas) with septic shock and acute renal failure treated with CPFA-CVVHD by using bicarbonate-based solutions (heparin-CPFA group, 58 sessions) or with CPFA-CVVHF using citrate (citrate-CPFA group, 36 sessions).


RESULTS
Plasma flow and used cartridges showed no differences between the citrate-CPFA and heparin-CPFA groups, while lost clotted cartridges were significantly lower in the citrate-CPFA group. Blood ionized calcium (iCa2+), Ca2+ infusion, pH and bicarbonates remained constant during citrate-CPFA, with no difference between pre- and post-cartridge plasma citrate. A significant positive correlation between iCa2+ in blood and ultrafiltrate was present.


CONCLUSIONS
These suits demonstrate the feasibility and safety of regional citrate anticoagulation in severely burned and polytrauma septic patients treated by CPFA.
Mariano
Filippo
F
Department of Medical Area, Nephrology and Dialysis Unit, CTO Hospital, Turin, Italy. dialisi@cto.to.it
Tetta
Ciro
C
Stella
Maurizio
M
Biolino
Piera
P
Miletto
Antonio
A
Triolo
Giorgio
G
D058186:Acute Kidney Injury / Q000209:etiology / Q000382:microbiology / Q000628:therapy; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D002056:Burns / Q000150:complications / Q000628:therapy; D002118:Calcium / Q000097:blood; D010478:Chemotherapy, Cancer, Regional Perfusion; D019343:Citric Acid / Q000008:administration & dosage* / Q000097:blood; D000075202:Contraindications; D016638:Critical Illness; D015314:Dialysis Solutions; D005260:Female; D006440:Hemofiltration; D006470:Hemorrhage / Q000517:prevention & control; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000150:complications / Q000628:therapy; D012772:Shock, Septic / Q000150:complications; D016060:Sorption Detoxification; D016896:Treatment Outcome
D000925:Anticoagulants; D015314:Dialysis Solutions; D019343:Citric Acid; D006493:Heparin; D002118:Calcium