Simplified citrate anticoagulation for continuous renal replacement therapy

Simplified citrate anticoagulation for continuous renal replacement therapy

Simplified citrate anticoagulation for continuous renal replacement therapy. Regional anticoagulation with trisodium citrate is an effective form of anticoagulation for continuous renal replacement therapy (CRRT) for patients with contraindications to heparin. However, because of the metabolic compl...

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Bibliographic Details
Published in:Kidney international Vol. 60; no. 1; pp. 370 - 374
Main Authors: Tolwani, Ashita J., Campbell, Ruth C., Schenk, Margaret B., Allon, Michael, Warnock, David G.
Format: Journal Article
Language:English
Published: New York, NY Elsevier Inc 01-07-2001
Nature Publishing
Elsevier Limited
Subjects:
acute renal failure
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Animals
Biological and medical sciences
bleeding complications
Cell Movement
citrate toxicity
critical care medicine
dialysate
dialysis
Emergency and intensive care: renal failure. Dialysis management
Humans
Intensive care medicine
Kidney - cytology
Kidney - physiology
Mast Cells - cytology
Mast Cells - physiology
Medical sciences
trisodium citrate
dialysis
critical care medicine
acute renal failure
trisodium citrate
dialysate
citrate toxicity
bleeding complications
Human
Citrate
Extrarenal dialysis
Anticoagulant
Continuous
Hemodialysis
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Summary:Simplified citrate anticoagulation for continuous renal replacement therapy. Regional anticoagulation with trisodium citrate is an effective form of anticoagulation for continuous renal replacement therapy (CRRT) for patients with contraindications to heparin. However, because of the metabolic complications of trisodium citrate, it is a complicated technique requiring specialized dialysis solutions. We have designed a simplified protocol for citrate regional anticoagulation for CRRT. Two percent trisodium citrate was delivered at 250 mL/h via the prefilter port of a COBE PRISMA device, with the rate adjusted to maintain a postfilter ionized calcium (iCa++) <0.5mmol/L. A central calcium gluconate infusion was used to maintain a systemic iCa++ at 1.1mmol/L. A standard dialysate solution consisting of 0.9% saline, KCl 3mmol/L, and MgSO4 1mmol/L was delivered at 1000 mL/h. We retrospectively reviewed the outcomes and complications associated with this protoco1 in 29 patients treated from July 1999 to October 1999, evaluating the frequency of clotting of the dialyzer, bleeding complications, citrate toxicity, and patient mortality. The Kaplan–Meier curve for dialyzer survival demonstrated a 61% survival rate at 48 hours. There were no episodes of significant bleeding or citrate toxicity. Seventy-two percent of patients died for reasons unrelated to CRRT. A CRRT protocol using regional 2% trisodium citrate anticoagulation is not associated with significant bleeding complications or citrate toxicity, and represents a simplified approach compared with previous applications using 4% trisodium citrate.
ISSN:0085-2538
1523-1755
DOI:10.1046/j.1523-1755.2001.00809.x