A comparison of two citrate anticoagulation regimens for continuous veno-venous hemofiltration.
OBJECTIVE
To assess the safety and efficacy of two different commercial citrate containing pre-filter replacement fluids during continuous veno-venous hemofiltration (CVVH) in patients with frequent filter clotting.


METHODS
Four intensive care units.


METHODS
Sixty-three critically ill patients with acute renal failure (ARF).


METHODS
Prospective observational study.


METHODS
We used a commercial citrate fluid (citrate: 11 mmol/L -fluid A) as predilution replacement for CVVH. We then changed to a new commercial citrate fluid (citrate: 14 mmol/L-fluid B) as replacement fluid and performed statistical comparisons. Replacement fluid rate was fixed at 2,000 ml/hour.


RESULTS
Filter life was 12.2 hour with fluid A compared with 17.1 hour with fluid B on average (p=0.0001). Mean post filter ionized calcium concentration was 0.52 mmol/L with fluid A compared with 0.40 mmol/L with fluid B (p<0.0001). Citrate intolerance led to cessation of treatment in one patient with fluid A and one patient with fluid B. Overall ionized calcium levels were higher (A: 1.18 vs B: 1.13 mmol/L; p<0.0001) and bicarbonate was lower (A: 22.4 vs B: 24.5 mmol/L; p<0.0001) during treatment with fluid A. Alkalemia was seen in 10 patients treated with fluid A and 16 patients treated with fluid B (NS).


CONCLUSIONS
We have developed a simple approach to regional citrate anticoagulation for CVVH using a commercial citrate-containing fluid as replacement fluid. Increasing citrate concentration from 11 to 14 mmol/L increased filter life while maintaining relative safety and simplicity.
Egi
M
M
Department of Intensive Care and Department of Medicine, Austin Hospital and Melbourne University, Melbourne - Australia.
Naka
T
T
Bellomo
R
R
Cole
L
L
French
C
C
Trethewy
C
C
Wan
L
L
Langenberg
C C
CC
Fealy
N
N
Baldwin
I
I
D058186:Acute Kidney Injury / Q000628:therapy*; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D002951:Citrates / Q000627:therapeutic use*; D016638:Critical Illness; D015314:Dialysis Solutions / Q000627:therapeutic use*; D005260:Female; D006440:Hemofiltration / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018709:Statistics, Nonparametric
D000925:Anticoagulants; D002951:Citrates; D015314:Dialysis Solutions