title: Experiences with Continuous Venovenous Hemofiltration using 18mmol/L predilution Citrate anticoagulation and a Phosphate Containing Replacement Solution.
abstract: BACKGROUND
  Regional citrate anticoagulation for continuous renal replacement therapy is associated with a longer filter-life, less bleeding events and improved mortality. Problems associated with using Prismocitrate 10/2 solution in continuous renal replacement therapy, include hypomagnesemia, hypophosphatemia and the need for additional bicarbonate infusion.
  
  
  OBJECTIVE
  This study uses the new Prismocitrate 18/0 solution for improved buffer balance and Phoxilium solution for a more favourable electrolyte profile.
  
  
  METHODS
  A retrospective analysis of patients who underwent continuous venovenous hemofiltration (CVVH) using Prismocitrate 18/0 and Phoxilium in our 21-bed ICU was conducted from March to July 2014.
  
  
  METHODS
  Continuous venovenous hemofiltration (CVVH) was performed at fixed rate by using Prismocitrate 18/0 predilution at 1250 ml/hour, a blood flow rate of 110 ml/min and post-replacement with Phoxilium at 1250 ml/hr. CVVH was run for 72 h or until filter clotting, transportation, or achievement of the clinical target.
  
  
  METHODS
  The results were displayed as the median with the interquartile range (IQR). The trend in pH, electrolytes, and base excess are shown using a standard box plot. All analyses were performed by the Statistical Package for Social Science for Windows, version 17 (SPSS, Chicago, IL, USA).
  
  
  RESULTS
  Forty-five CVVH episodes were analysed. The median circuit lifetime was 44 h (interquartile range, IQR 29-55). Metabolic alkalosis, hypophosphatemia and hypomagnesemia occurred in 8.3%, 3.5% and 40.2% of the blood samples, respectively. No patient developed hypokalemia or citrate toxicity.
  
  
  CONCLUSIONS
  This new CVVH regime is safe and easy to administer for critically ill patients.
authors.affiliation: Department of Intensive Care, Intensive Care Unit, Queen Elizabeth Hospital, Kowloon, Hong Kong.
authors.forename: Yuen Henry
authors.initials: YH
authors.lastname: Jeffrey
authors.affiliation: Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong.
authors.forename: Shum
authors.initials: S
authors.lastname: Hoi-Ping
authors.affiliation: Department of Intensive Care, Intensive Care Unit, Queen Elizabeth Hospital, Kowloon, Hong Kong.
authors.forename: Anne Leung
authors.initials: AL
authors.lastname: Kit Hung
authors.affiliation: Department of Intensive Care, Intensive Care Unit, Queen Elizabeth Hospital, Kowloon, Hong Kong.
authors.forename: Lam
authors.initials: L
authors.lastname: Chung-Ling
authors.affiliation: Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong.
authors.forename: Yan
authors.initials: Y
authors.lastname: Wing-Wa
authors.affiliation: Department of Intensive Care, Intensive Care Unit, Queen Elizabeth Hospital, Kowloon, Hong Kong.
authors.forename: Lai
authors.initials: L
authors.lastname: King-Yiu
keywords: Acute renal failure; anticoagulation; citrate; continuous renal replacement therapy