Quality indicators in prolonged hemodialysis with regional citrate anticoagulation with the genius system: retrospective cohort of critical patients with acute kidney injury

• Published in: BMC nephrology Vol. 24; no. 1; p. 353
• Main Authors: Vieira, Jorge Alberto Menegasso, Reinheimer, Isabel Cristina, Dos Santos, Amanda Corrêa, Halperin, Fernando Kowarick, Susin, Luiza Aguirre, Staub, Lia Portella, Ribeiro, Raquel Jaqueline Eder, da Silveira, Julia Braga, Fontoura, Lucas Friedrich, de Souza, Diego Candido, Nunes, Karen Patrícia, de Souza, Vandrea Carla, da Silva Selistre, Luciano, Poli-de-Figueiredo, Carlos Eduardo
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 30-11-2023; BioMed Central; BMC
• Subjects: Acute Kidney Injury - therapy; Acute renal failure; Alkalosis; Anticoagulants; Anticoagulants (Medicine); Anticoagulants - therapeutic use; Care and treatment; Chloride; Citrates - therapeutic use; Citric acid; Citric Acid - therapeutic use; Clotting; COVID-19; Critical Illness - therapy; Data collection; Dialysate; Dosage and administration; Electrolytes; Hemodialysis; Hemodynamics; Heparin; Heparin - adverse effects; Hospitals; Humans; Hybrid renal replacement therapy; Kidneys; Medical care; Metabolism; Methods; Mortality; Nephrology; Potassium; Quality Indicators, Health Care; Quality management; Regional citrate anticoagulation; Renal Dialysis; Retrospective Studies; Safety and security measures; SLED technique; Slow extended dialysis mode; Sodium; Sodium Citrate; Sustained low-efficiency dialysis; Thrombosis; Brazil; Slow extended dialysis mode; Sustained low-efficiency dialysis; Regional citrate anticoagulation; SLED technique; Hybrid renal replacement therapy
• DOI: 10.1186/s12882-023-03342-8
• EISSN: 1471-2369

Prolonged hemodialysis (HD) is performed from 6 to 12 h and can last up to 24 h. To prevent system clotting some studies suggest that Regional Citrate Anticoagulation (RCA) use reduces bleeding rates relative to systemic heparin. However, there may be difficulties in the patient's clinical management and completing the prescribed HD with Genius system using RCA.
To analyze safety Quality Indicators (IQs) and follow up on prolonged HD with 4% sodium citrate solution in a Genius® hybrid system.
This is a retrospective cohort conducted in an intensive care unit.
53 random sessions of prolonged HD with 4% sodium citrate solution of critically ill patients with AKI assessed. Evaluated safety indicators were dysnatremia and metabolic alkalosis, observed in 15% and 9.4% of the sessions, respectively. Indicators of effectiveness were system clotting which occurred in 17.3%, and the minimum completion of the prescribed HD time, which was 75.5%.
The assessment of the indicators showed that the use of RCA with a 4% sodium citrate solution in prolonged HD with the Genius system in critically ill patients with AKI can be performed in a simple, safe, and effective way.