title: Sensors and hybrid therapies: a new approach with automated citrate anticoagulation.
abstract: BACKGROUND
  Hybrid therapies use intermittent hemodialysis (IHD) machines adapted to provide prolonged intermittent or continuous renal replacement therapy in the intensive care unit (ICU). Despite the low cost, hybrid therapy use is limited warranting a novel approach.
  
  
  METHODS
  The literature was reviewed for limitations of hybrid protocols, use of regional citrate anticoagulation (RCA) on hybrid systems and sensors for IHD and hybrid therapy. The novel hybrid program in the authors' institution is presented as a plausible future direction for the modality.
  
  
  RESULTS
  Hybrid therapies are limited by access flow and clotting alarms. Technology limitations render many IHD sensors inoperable at low dialysate flow. A synergy with RCA allows a novel, safe approach with low blood flows and high dialysate flows with alarm- and clotting-free operation and all commercial IHD sensors functional.
  
  
  CONCLUSIONS
  The low cost, ease of use, safety and efficacy of hybrid therapy with near-automated RCA may lead to rapid expansion of this form of ICU renal support.
authors.affiliation: Division of Nephrology and Hypertension, Henry Ford Health System, Detroit, MI 48202, USA. bszamos1@hfhs.org
authors.forename: Balazs
authors.initials: B
authors.lastname: Szamosfalvi
authors.forename: Stanley
authors.initials: S
authors.lastname: Frinak
authors.forename: Jerry
authors.initials: J
authors.lastname: Yee
mesh_terms: D058186:Acute Kidney Injury / Q000628:therapy*; D000925:Anticoagulants / Q000627:therapeutic use*; D001331:Automation / Q000191:economics / Q000295:instrumentation*; D001811:Blood Volume Determination / Q000295:instrumentation; D001831:Body Temperature; D002951:Citrates / Q000627:therapeutic use*; D004868:Equipment Failure; D006400:Hematocrit / Q000295:instrumentation; D006801:Humans; D007668:Kidney / Q000293:injuries; D010100:Oxygen / Q000032:analysis; D017582:Renal Replacement Therapy / Q000191:economics / Q000295:instrumentation*
chemical_list: D000925:Anticoagulants; D002951:Citrates; D010100:Oxygen