Continuous venovenous hemofiltration with or without predilution regional citrate anticoagulation: a prospective study.
OBJECTIVE
Continuous venovenous hemofiltration (CVVH) requires anticoagulation to prevent circuit clotting and its use is contraindicated in patients with high bleeding risk. The aim of this study was to compare CVVH with and without regional citrate anticoagulation (RCA) with respect to filter life, azotemic control and cost.


METHODS
This was a prospective sequential cohort study. The first cohort of patients with a high bleeding risk and acute renal failure was treated by anticoagulant-free predilution CVVH (n = 31). In the second cohort, CVVH was applied with RCA (n = 20).


RESULTS
The median filter life was 41 h (interquartile range 20-62) with RCA and 12 h (8-28) without RCA (p = 0.001). The azotemic control was better in the group with RCA. The hourly cost was comparable between the two groups.


CONCLUSIONS
Regional anticoagulation with citrate-based replacement solution improved filter life compared to anticoagulant-free predilution CVVH. This regimen appeared safe, feasible and without metabolic complications or increased costs.
Nurmohamed
S Azam
SA
Department of Nephrology, VU University Medical Center, Amsterdam, The Netherlands. SA.Nurmohamed@VUMC.nl
Vervloet
Marc G
MG
Girbes
Armand R J
AR
Ter Wee
Pieter M
PM
Groeneveld
A B Johan
AB
D058186:Acute Kidney Injury / Q000150:complications / Q000628:therapy*; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D002118:Calcium / Q000008:administration & dosage; D002951:Citrates / Q000008:administration & dosage* / Q000009:adverse effects; D015331:Cohort Studies; D003422:Critical Care / Q000379:methods; D004868:Equipment Failure; D005260:Female; D006440:Hemofiltration / Q000379:methods*; D006470:Hemorrhage / Q000139:chemically induced / Q000517:prevention & control; D006474:Hemorrhagic Disorders / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D000077559:Sodium Citrate; D012996:Solutions
D000925:Anticoagulants; D002951:Citrates; D012996:Solutions; D000077559:Sodium Citrate; D002118:Calcium