title: Delay in onset of metabolic alkalosis during regional citrate anti-coagulation in continuous renal replacement therapy with calcium-free replacement solution.
abstract: Regional citrate anti-coagulation for continuous renal replacement therapy chelates calcium to produce the anti- coagulation effect. We hypothesise that a calcium-free replacement solution will require less citrate and produce fewer metabolic side effects. Fifty patients, in a Medical Intensive Care Unit of a tertiary teaching hospital (25 in each group), received continuous venovenous hemofiltration using either calcium-containing or calcium-free replacement solutions. Both groups had no significant differences in filter life, metabolic alkalosis, hypernatremia, hypocalcemia, and hypercalcemia. However, patients using calcium-containing solution developed metabolic alkalosis earlier, compared to patients using calcium-free solution (mean 24.6 hours,CI 0.8-48.4 vs. 37.2 hours, CI 9.4-65, P = 0.020). When calcium-containing replacement solution was used, more citrate was required (mean 280 ml/h, CI 227.2-332.8 vs. 265 ml/h, CI 203.4-326.6, P = 0.069), but less calcium was infused (mean 21.2 ml/h, CI 1.2-21.2 vs 51.6 ml/h, CI 26.8-76.4, P < or = 0.0001).
authors: Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, 5 Lower Kent Ridge Road, Singapore-119 074.
authors: Kay Choong
authors: KC
authors: See
authors: Margaret
authors: M
authors: Lee
authors: Amartya
authors: A
authors: Mukhopadhyay
mesh_terms: D000368:Aged; D000471:Alkalosis / Q000139:chemically induced* / Q000453:epidemiology; D000925:Anticoagulants / Q000627:therapeutic use*; D002118:Calcium / Q000009:adverse effects*; D002951:Citrates / Q000627:therapeutic use*; D005260:Female; D015312:Hemodialysis Solutions / Q000627:therapeutic use*; D006440:Hemofiltration / Q000295:instrumentation; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D017582:Renal Replacement Therapy; D012189:Retrospective Studies
chemical_list: D000925:Anticoagulants; D002951:Citrates; D015312:Hemodialysis Solutions; D002118:Calcium