title: The effects of a novel calcium-free lactate buffered dialysis and substitution fluid for regional citrate anticoagulation--prospective feasibility study.
abstract: BACKGROUND
  Testing metabolic effects of a novel calcium-free, magnesium, phosphate and lactate containing solution (Lactocitrate) in combination with citrate anticoagulation.
  
  
  METHODS
  Patients on CRRT (2,000 ml/h, blood flow (Qb) 100 ml/min, trisodium citrate (4% TSC)) with arterial lactate <3 mmol/l were included. At start, bicarbonate-buffered fluid was changed to Lactocitrate and the substitution of magnesium and phosphorus ceased. At 9 h the Qb was increased to 150 ml/min. At 18 h the CRRT dosage was increased to 3,000 ml/h.
  
  
  RESULTS
  In 22 CVVHDF patients and another 23 on CVVH the pH, aHCO3 and Na (all p > 0.05) showed no significant changes regardless of the increased dosage of 4% TSC at 9 h (p < 0.001). Mgtot and phosphorus stabilised within normal range. Arterial lactate increased to 1.9 (1.6-2.6) mmol/l at 3,000 ml/h, p < 0.001). Citrate- and lactate-related energetic gains were up to 74 (61-86) kJ/h.
  
  
  CONCLUSIONS
  The fluid performed well within ordinary CRRT dosage and Qb up to 150 ml/min. Lactate levels mildly increased and no magnesium and phosphorus replenishments were necessary.
authors.affiliation: Department of Anaesthesiology and Intensive Care, First Faculty of Medicine, Charles University and General University Hospital, Prague 2, Czech Republic.
authors.forename: Martin
authors.initials: M
authors.lastname: Balik
authors.forename: Michael
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: Rulisek
authors.forename: Helena
authors.initials: H
authors.lastname: Brodska
authors.forename: Martin
authors.initials: M
authors.lastname: Stritesky
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001786:Blood Glucose / Q000032:analysis; D002021:Buffers; D018592:Cross-Over Studies; D004347:Drug Interactions; D057915:Drug Substitution; D004734:Energy Metabolism / Q000187:drug effects; D005240:Feasibility Studies; D005260:Female; D005947:Glucose / Q000009:adverse effects / Q000627:therapeutic use*; D017583:Hemodiafiltration; D015312:Hemodialysis Solutions / Q000009:adverse effects / Q000737:chemistry / Q000627:therapeutic use*; D006440:Hemofiltration; D006801:Humans; D007773:Lactates / Q000097:blood; D007785:Lactose / Q000009:adverse effects / Q000627:therapeutic use*; D008275:Magnesium Deficiency / Q000139:chemically induced / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption / Q000187:drug effects; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000097:blood / Q000628:therapy
chemical_list: D000925:Anticoagulants; D001786:Blood Glucose; D002021:Buffers; D015312:Hemodialysis Solutions; D007773:Lactates; D005947:Glucose; D007785:Lactose