A simple, safe and effective citrate anticoagulation protocol for the genius dialysis system in acute renal failure.
BACKGROUND
The Genius dialysis system is a close loop dialysis batch system increasingly used as an intermittent hemodialysis device in intensive care units. The aim of this study was to test the safety and feasibility of a regional citrate anticoagulation protocol with respect to acid-base and electrolyte disarrangements in critically ill patients with acute renal failure. A standard heparin anticoagulation protocol served as control.


RESULTS
In a cross-over study design, 27 acute renal failure patients were allocated to a citrate- and heparin-anticoagulated dialysis sessions (4-6 h). For citrate anticoagulation, a 4% sodium-citrate solution was infused into the arterial line of the extracorporeal circuit. A low calcium dialysate (1 mmol/l) was used for all dialysis sessions. Citrate dosing was adjusted according to the post-filter ionized calcium concentration (targeted values 0.5-0.7 mmol/l). There was no routine calcium substitution. Heparin anticoagulation was started with a heparin-loading dose followed by an individual, patient-adjusted continuous heparin infusion. Electrolyte disarrangements, namely hypernatremia, hypo- and hypercalcemia did not occur in either group. Although the highest bicarbonate levels were achieved during citrate anticoagulation (p = 0.021 versus heparin) the acid base values remained equilibrated in both groups. Filter longevity was excellent and the targeted dialysis time was achieved in all but 1 patient. Citrate anticoagulation was well tolerated with respect to cardiovascular hemodynamics.


CONCLUSIONS
Citrate anticoagulation can be safely and effectively performed during intermittent Genius dialysis. Calcium supplementation is not routinely required.
Morgera
Stanislao
S
Department of Nephrology, Charité, Humboldt University of Berlin, Berlin, Germany. stanislao.morgera@charite.de
Scholle
Cornelia
C
Melzer
Christoph
C
Slowinski
Torsten
T
Liefeld
Lutz
L
Baumann
Gerd
G
Peters
Harm
H
Neumayer
Hans-H
HH
D000136:Acid-Base Equilibrium; D058186:Acute Kidney Injury / Q000378:metabolism / Q000628:therapy*; D000925:Anticoagulants / Q000008:administration & dosage*; D002951:Citrates / Q000008:administration & dosage*; D002985:Clinical Protocols; D018592:Cross-Over Studies; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D008875:Middle Aged; D006435:Renal Dialysis / Q000379:methods*
D000925:Anticoagulants; D002951:Citrates; D006493:Heparin