title: The use of regional citrate anticoagulation for continuous venovenous hemodiafiltration in acute kidney injury.
abstract: OBJECTIVE
  Continuous renal replacement therapy is commonly used in the treatment of acute kidney injury. Although the optimal anticoagulation system is not well defined, citrate has emerged as the most promising method. We evaluated the data of 143 patients with acute kidney injury subjected to citrate-based continuous venovenous hemodiafiltration.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Intensive care unit of tertiary care private hospital.
  
  
  METHODS
  Patients with acute kidney injury treated from February 2004 to July 2006.
  
  
  METHODS
  None.
  
  
  RESULTS
  The main cause of acute kidney injury was sepsis (58%). The mean dialysis dose was 36.6 mL/kg/hr allowing for excellent metabolic control (last tests: creatinine, 1.1 mg/dL; urea, 46 mg/dL). No significant bleeding, severe electrolyte, or calcium disorders were observed. Of the 418 filters used, almost 28,000 hrs of treatment, hemofilter patency was 68% at 72 hrs. Hospital mortality was 59%, and 22% of survivors were dialysis-dependent at the time of discharge. Within our sample, we identified 21 patients with liver failure (mean prothrombin time index, 21% vs. 67%, p < 0.001). This group presented with a lesser median systemic ionized calcium level (1.06 vs. 1.12 mmol/L, p < 0.001) and similar mean total calcium level (8.5 vs. 8.6 mg/dL, not significant), compared with patients without liver failure. These subjects also showed acidemia (median pH, 7.31 vs. 7.40, p < 0.001); however, they exhibited higher levels of lactate (median 29 vs. 16 mg/dL, p < 0.001), chloride (mean 109 vs. 107 mEq/L, p = 0.045) and had a trend to higher mortality rate (76% vs. 56%).
  
  
  CONCLUSIONS
  Besides a trend toward higher mortality rate observed in the group with liver failure, we found that citrate-based continuous venovenous hemodiafiltration allowed an effective dialysis dose and reasonable filter patency.
authors.affiliation: Intensive Care Unit, Nephrology Support Group, Hospital Israelita Albert Einstein, Sao Paulo, Brazil. marcelino@einstein.br
authors.forename: Marcelino S
authors.initials: MS
authors.lastname: Durão
authors.forename: Julio C M
authors.initials: JC
authors.lastname: Monte
authors.forename: Marcelo C
authors.initials: MC
authors.lastname: Batista
authors.forename: Moacir
authors.initials: M
authors.lastname: Oliveira
authors.forename: Ilson J
authors.initials: IJ
authors.lastname: Iizuka
authors.forename: Bento F
authors.initials: BF
authors.lastname: Santos
authors.forename: Virgilio G
authors.initials: VG
authors.lastname: Pereira
authors.forename: Miguel
authors.initials: M
authors.lastname: Cendoroglo
authors.forename: Oscar F P
authors.initials: OF
authors.lastname: Santos
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D002951:Citrates / Q000008:administration & dosage* / Q000009:adverse effects; D015331:Cohort Studies; D003422:Critical Care; D005260:Female; D017583:Hemodiafiltration / Q000379:methods*; D006801:Humans; D017093:Liver Failure / Q000150:complications; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018805:Sepsis / Q000150:complications; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D002951:Citrates