title: Regional citrate anticoagulation for pediatric CRRT using integrated citrate software and physiological sodium concentration solutions.
abstract: BACKGROUND
  In continuous renal replacement therapy (CRRT), regional citrate anticoagulation offers an attractive alternative to heparinization, especially for children with a high bleeding risk.
  
  
  METHODS
  We report on a new management approach to CRRT using integrated citrate software and physiological sodium concentration solutions. Convective filtration was performed with pre-filter citrate anticoagulation using an 18 mmol/L citrate solution and a post-filter replacement fluid. The citrate flow rate was automatically adjusted to the blood flow rate by means of integrated citrate software. Similarly, calcium was automatically infused into children to maintain their blood calcium levels within normal range.
  
  
  RESULTS
  Eleven CRRT sessions were performed (330 h) in seven critically ill children aged 3-15 years (extreme values 15-66 kg). Disease categories included sepsis with multiorgan dysfunction (n = 2) and hemolytic uremic syndrome (n = 5). Median effluent dose was 2.1 (extreme values 1.7-3.3) L/h/1.73 m2. No session had to be stopped because of metabolic complications. Calcium levels, both in the circuits and in the circulating blood of the children, remained stable and secure.
  
  
  CONCLUSIONS
  Regional citrate anticoagulation can be used in children with a body weight of >15 kg using integrated citrate software and commercially available solutions with physiological sodium concentrations in a safe, effective and convenient procedure.
authors: Unité de Réanimation Pédiatrique, Pôle Femme-Enfant-Adolescent, Centre hospitalier universitaire (CHU) de Nantes, 38 Boulevard Jean-Monnet, 44093, Nantes, France, jeanmichel.liet@chu-nantes.fr.
authors: Jean-Michel
authors: JM
authors: Liet
authors: Emma
authors: E
authors: Allain-Launay
authors: Bénédicte
authors: B
authors: Gaillard-LeRoux
authors: François
authors: F
authors: Barrière
authors: Alexis
authors: A
authors: Chenouard
authors: Jean-Marc
authors: JM
authors: Dejode
authors: Nicolas
authors: N
authors: Joram
mesh_terms: D000293:Adolescent; D000925:Anticoagulants / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D019343:Citric Acid / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D017582:Renal Replacement Therapy / Q000379:methods*; D012965:Sodium Chloride / Q000627:therapeutic use; D012984:Software
chemical_list: D000925:Anticoagulants; D019343:Citric Acid; D012965:Sodium Chloride