title: Regional citrate anticoagulation in predilution continuous venovenous hemofiltration using prismocitrate 10/2 solution.
abstract: Regional citrate anticoagulation (RCA) for continuous renal replacement therapy (CRRT) is associated with a longer filter life and fewer bleeding events. Complexity of the regimen is the major hurdle preventing widespread application. This study describes a simple predilution continuous venovenous hemofiltration (CVVH) protocol utilizing a commercially prepared replacement solution containing citrate (Prismocitrate 10/2). Ten patients with acute renal failure were evaluated. The Prismaflex system was used for predilution CVVH, with Prismocitrate 10/2 running at 2500 mL/h as the main predilution replacement. An 8.4% sodium bicarbonate solution was infused at 50 mL/h in the first 2 h followed by 30 mL/h; 10% calcium gluconate was given to achieve an ionized calcium (iCa) level of 1-1.2 mmol/L. The circuit was run for 72 h unless there was filter clotting, transportation was required, or the patient did not require further CRRT. Total treatment duration was 504.5 h. The post-dilution equivalent ultrafiltration rate was 32.9 mL/kg/h (interquartile range [IQR] 31.6-38.2) and the median circuit life was 50.3 h (IQR 25.5-72.0). None of the circuit was changed due to circuit clotting. The median systemic iCa was 0.98 mmol/L (IQR 0.91-1.08). The total calcium-to-iCa ratio was 2.33 (IQR 2.21-2.45). None of the patients developed hypernatremia (Na ≥ 150 mmol/L) or citrate toxicity (total Ca-to-iCa ratio > 2.5 plus increasing metabolic acidosis), and metabolic alkalosis (pH ≥ 7.5) occurred in one patient. This simple RCA CVVH protocol using commercially-prepared solution could be a feasible, relatively safe, and effective alternative to the conventional regimen for patients with a body weight up to 80 kg.
authors.affiliation: Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China. shumhp@ha.org.hk
authors.forename: Hoi-Ping
authors.initials: HP
authors.lastname: Shum
authors.forename: King-Chung
authors.initials: KC
authors.lastname: Chan
authors.forename: Wing-Wa
authors.initials: WW
authors.lastname: Yan
mesh_terms: D058186:Acute Kidney Injury / Q000628:therapy*; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D002125:Calcium Gluconate / Q000008:administration & dosage; D019343:Citric Acid / Q000008:administration & dosage*; D005260:Female; D015312:Hemodialysis Solutions / Q000737:chemistry; D006440:Hemofiltration; D006801:Humans; D008297:Male; D008875:Middle Aged; D017693:Sodium Bicarbonate / Q000008:administration & dosage
chemical_list: D000925:Anticoagulants; D015312:Hemodialysis Solutions; D019343:Citric Acid; D017693:Sodium Bicarbonate; D002125:Calcium Gluconate