title: Bioenergetic gain of citrate anticoagulated continuous hemodiafiltration--a comparison between 2 citrate modalities and unfractionated heparin.
abstract: OBJECTIVE
  To determine bioenergetic gain of 2 different citrate anticoagulated continuous hemodiafiltration (CVVHDF) modalities and a heparin modality.
  
  
  METHODS
  We compared the bio-energetic gain of citrate, glucose and lactate between 29 patients receiving 2.2% acid-citrate-dextrose with calcium-containing lactate-buffered solutions (ACD/Ca(plus)/lactate), 34 on 4% trisodium citrate with calcium-free low-bicarbonate buffered fluids (TSC/Ca(min)/bicarbonate), and 18 on heparin with lactate buffering (Hep/lactate).
  
  
  RESULTS
  While delivered CVVHDF dose was about 2000 mL/h, total bioenergetic gain was 262 kJ/h (IQR 230-284) with ACD/Ca(plus)/lactate, 20 kJ/h (8-25) with TSC/Ca(min)/bicarbonate (P < .01) and 60 kJ/h (52-76) with Hep/lactate. Median patient delivery of citrate was 31.2 mmol/h (25-34.7) in ACD/Ca(plus)/lactate versus 14.8 mmol/h (12.4-19.1) in TSC/Ca(min)/bicarbonate groups (P < .01). Median delivery of glucose was 36.8 mmol/h (29.9-43) in ACD/Ca(plus)/lactate, and of lactate 52.5 mmol/h (49.2-59.1) in ACD/Ca(plus)/lactate and 56.1 mmol/h (49.6-64.2) in Hep/lactate groups. The higher energy delivery with ACD/Ca(plus)/lactate was partially due to the higher blood flow used in this modality and the calcium-containing dialysate.
  
  
  CONCLUSIONS
  The bioenergetic gain of CVVHDF comes from glucose (in ACD), lactate and citrate. The amount substantially differs between modalities despite a similar CVVHDF dose and is unacceptably high when using ACD with calcium-containing lactate-buffered solutions and a higher blood flow. When calculating nutritional needs, we should account for the energy delivered by CVVHDF.
authors.affiliation: Department of Anaesthesiology and Intensive Care, First Faculty of Medicine, Charles University and General University Hospital, U nemocnice 2, Prague 2, 120 00, Czech Republic. martin.balik@post.cz
authors.forename: Martin
authors.initials: M
authors.lastname: Balik
authors.forename: Mykhaylo
authors.initials: M
authors.lastname: Zakharchenko
authors.forename: Pavel
authors.initials: P
authors.lastname: Leden
authors.forename: Michal
authors.initials: M
authors.lastname: Otahal
authors.forename: Jan
authors.initials: J
authors.lastname: Hruby
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Polak
authors.forename: Katerina
authors.initials: K
authors.lastname: Rusinova
authors.forename: Zdenek
authors.initials: Z
authors.lastname: Stach
authors.forename: Monika
authors.initials: M
authors.lastname: Tokarik
authors.forename: Jaroslava
authors.initials: J
authors.lastname: Vavrova
authors.forename: Antonin
authors.initials: A
authors.lastname: Jabor
authors.forename: Heleen M
authors.initials: HM
authors.lastname: Oudemans-van Straaten
mesh_terms: D058186:Acute Kidney Injury / Q000628:therapy*; D000925:Anticoagulants / Q000009:adverse effects / Q000191:economics / Q000494:pharmacology*; D002951:Citrates / Q000009:adverse effects / Q000191:economics / Q000494:pharmacology*; D015314:Dialysis Solutions / Q000009:adverse effects / Q000191:economics / Q000494:pharmacology*; D002149:Energy Intake / Q000187:drug effects*; D004734:Energy Metabolism / Q000187:drug effects*; D005260:Female; D017048:Health Care Costs; D017583:Hemodiafiltration / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D006493:Heparin / Q000009:adverse effects / Q000191:economics / Q000494:pharmacology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014883:Water-Electrolyte Imbalance / Q000209:etiology / Q000517:prevention & control
chemical_list: D000925:Anticoagulants; D002951:Citrates; D015314:Dialysis Solutions; D006493:Heparin