Regional citrate anticoagulation for continuous renal replacement therapy in severe burns—A retrospective analysis of a protocol-guided approach

Regional citrate anticoagulation for continuous renal replacement therapy in severe burns—A retrospective analysis of a protocol-guided approach

Abstract Introduction For critically ill patients, the use of regional citrate anticoagulation as part of continuous renal replacement therapy (CRRT) has become increasingly common in recent years. However, there are scarce data on the use of this technique in patients with burns. The aim of this st...

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Bibliographic Details
Published in:Burns Vol. 40; no. 8; pp. 1593 - 1601
Main Authors: Gille, Jochen, Sablotzki, Armin, Malcharek, Michael, Raff, Thomas, Mogk, Martin, Parentin, Torsten
Format: Journal Article
Language:English
Published: Netherlands Elsevier Ltd 01-12-2014
Subjects:
Acute kidney injury
Acute Kidney Injury - etiology
Acute Kidney Injury - therapy
Aged
Anticoagulants - therapeutic use
Body Surface Area
Burns
Burns - complications
Burns - therapy
Citrate anticoagulation
Citric Acid - therapeutic use
Clinical Protocols
Critical Care
Dialysis
Female
Hemodiafiltration - methods
Humans
Male
Middle Aged
Renal Replacement Therapy
Retrospective Studies
Trauma Severity Indices
Germany, Sachsen, Leipzig
Dialysis
Citrate anticoagulation
Burns
Acute kidney injury
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Summary:Abstract Introduction For critically ill patients, the use of regional citrate anticoagulation as part of continuous renal replacement therapy (CRRT) has become increasingly common in recent years. However, there are scarce data on the use of this technique in patients with burns. The aim of this study was to examine the effectiveness, feasibility and complications of regional citrate anticoagulation for CRRT in burn patients, as well as the effects on coagulation and the electrolyte and acid–base balance. Methods This retrospective study included all patients who received renal replacement therapy with citrate anticoagulation to treat acute kidney injury (AKI) between January 1, 2004 and December 31, 2009 at the burn unit of St. Georg Hospital GmbH in Leipzig. Results During the examination period, 18 patients were treated using CRRT with regional citrate anticoagulation (CVVHDF in the pre-dilution mode). The median patient age was 64 years (49.5; 71), with a median TBSA of 42.5% (33.25; 52.5) and a median ABSI score of 10 (9; 10). The CRRT was initiated on a median of 6 days (4; 8.75) after admission to the hospital and continued for a median duration of 7 days (5; 8). The median dialysis dose was 38.2 ml kg BW−1 h−1 (31.8; 42.1). The median effective filter operation time was 67 h (46; 72). No relevant disorders associated with acid–base balance, electrolytes or coagulation occurred, and there were no bleeding complications. Conclusion In terms of bleeding risk and electrolyte and acid–base balance, regional citrate anticoagulation may be considered to be an effective, safe and user-friendly procedure for patients with severe burns and AKI.
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ISSN:0305-4179
1879-1409
DOI:10.1016/j.burns.2014.01.028