title: A comparison of two citrate anticoagulation regimens for continuous veno-venous hemofiltration.
abstract: 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.
authors.affiliation: Department of Intensive Care and Department of Medicine, Austin Hospital and Melbourne University, Melbourne - Australia.
authors.forename: M
authors.initials: M
authors.lastname: Egi
authors.forename: T
authors.initials: T
authors.lastname: Naka
authors.forename: R
authors.initials: R
authors.lastname: Bellomo
authors.forename: L
authors.initials: L
authors.lastname: Cole
authors.forename: C
authors.initials: C
authors.lastname: French
authors.forename: C
authors.initials: C
authors.lastname: Trethewy
authors.forename: L
authors.initials: L
authors.lastname: Wan
authors.forename: C C
authors.initials: CC
authors.lastname: Langenberg
authors.forename: N
authors.initials: N
authors.lastname: Fealy
authors.forename: I
authors.initials: I
authors.lastname: Baldwin
mesh_terms: 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
chemical_list: D000925:Anticoagulants; D002951:Citrates; D015314:Dialysis Solutions