[Regional citrate anticoagulation for continuous haemodiafiltration in the postoperative period].
BACKGROUND
Continuous renal replacement therapy (CRRT) is commonly used for the treatment of acute renal failure in haemodynamically unstable patients after cardiac surgery. The main problem associated with CRRT is the need for systemic anticoagulation that may lead to bleeding complications. As an alternative to heparins, and to avoid systemic anticoagulation, the use of regional citrate infusion has been proposed for patients with a high risk of bleeding.


METHODS
We present the clinical course of three patients with a high risk of bleeding after cardiac surgery in which CRRT, based on regional citrate anticoagulation, was conducted safely. Circuit survival times were over 80 hours and filters were changed on schedule, without any signs of dysfunction. Metabolic alkalosis was observed in one patient, who was treated by reducing the circuit blood flow and increasing the dialisate flow. One patient required chronic dialysis, the other two recovering after short-term CRRT.


CONCLUSIONS
Regional citrate anticoagulation during CRRT should be used as a method of choice in patients with a high risk of haemorrhage in the postoperative period.
Kucewicz
Ewa
E
'Oddział Kliniczny Kardioanestezji i Intensywnej Terapii Slaskiego Uniwersytetu Medycznego, Slaskie Centrum Chorób Serca w Zabrzu. kardanest@sum.edu.pl
Zegleń
Sławomir
S
Wojarski
Jacek
J
Ochman
Marek
M
Skuza
Katarzyna
K
Szczepańska
Anna
A
Podwińska
Ewa
E
Pacholewicz
Jerzy
J
Przybylski
Roman
R
D058186:Acute Kidney Injury / Q000628:therapy*; D000328:Adult; D000471:Alkalosis / Q000139:chemically induced; D000925:Anticoagulants / Q000008:administration & dosage*; D002951:Citrates / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D017583:Hemodiafiltration / Q000379:methods*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D011184:Postoperative Period
D000925:Anticoagulants; D002951:Citrates