title: [Continuous haemodialysis with citrate anticoagulation in patients with liver failure: three cases].
abstract: Regional citrate anticoagulation for continuous renal replacement therapy provides an efficient alternative to heparin as it reduces the likelihood of haemorrhage in critically ill patients with bleeding risk or coagulopathy and increases the haemofilter survival time. Liver failure is a classic contraindication of regional citrate anticoagulation since it carries the risk of citrate accumulation and its metabolic complications, although it could be attractive for this population of patients with high bleeding risk. We report three cases of continuous haemodialysis with regional citrate anticoagulation performed in patients with severe acute liver failure, without accumulation in two cases and with a suspected beginning of accumulation in the third case. For these patients, close monitoring of the total-to-ionized calcium ratio, pH and anion gap is particularly essential to control the safety of citrate infusion. Increasing effluent flow rate eliminates more calcium-bound citrate and therefore limits citrate accumulation and its consequences.
authors.affiliation: Service d'anesthésie-réanimation, pavillon P réanimation, hôpital Édouard-Herriot, 5, place d'Arsonval, 69437 Lyon cedex 03, France.
authors.forename: P
authors.initials: P
authors.lastname: Devauchelle
authors.forename: M
authors.initials: M
authors.lastname: Page
authors.forename: P
authors.initials: P
authors.lastname: Brun
authors.forename: C-E
authors.initials: CE
authors.lastname: Ber
authors.forename: J
authors.initials: J
authors.lastname: Crozon
authors.forename: J-J
authors.initials: JJ
authors.lastname: Baillon
authors.forename: B
authors.initials: B
authors.lastname: Allaouchiche
authors.forename: T
authors.initials: T
authors.lastname: Rimmelé
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology / Q000628:therapy; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D002118:Calcium / Q000097:blood / Q000378:metabolism; D019343:Citric Acid / Q000009:adverse effects / Q000097:blood / Q000627:therapeutic use*; D017809:Fatal Outcome; D005260:Female; D006526:Hepatitis C / Q000150:complications; D006801:Humans; D006863:Hydrogen-Ion Concentration; D015470:Leukemia, Myeloid, Acute / Q000150:complications; D008103:Liver Cirrhosis / Q000150:complications; D017114:Liver Failure, Acute / Q000188:drug therapy / Q000628:therapy*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000379:methods*; D017582:Renal Replacement Therapy; D012772:Shock, Septic / Q000150:complications / Q000628:therapy
chemical_list: D000925:Anticoagulants; D019343:Citric Acid; D002118:Calcium