Regional citrate anticoagulation in CVVH: A new protocol combining citrate solution with a phosphate-containing replacement fluid

Hemodialysis International

Volumn 17, Issue 2, 2013, Pages 313-320

  Morabito, Santo ^a   Pistolesi, Valentina ^a   Tritapepe, Luigi ^b   Zeppilli, Laura ^a   Polistena, Francesca ^a   Fiaccadori, Enrico ^c   Pierucci, Alessandro ^a  

^a POLICLINICO UMBERTO I   (Italy)

^b SAPIENZA UNIVERSITY OF ROME   (Italy)

^c UNIVERSITY OF PARMA MEDICAL SCHOOL   (Italy)

Author keywords

Acute kidney injury; Citrate; CVVH; Hypophosphatemia; Phosphate; Regional citrate anticoagulation

Indexed keywords

ANTICOAGULANT AGENT; BICARBONATE; CITRIC ACID; ELECTROLYTE; HEMODIALYSIS FLUID; HEPARIN CALCIUM; HYPERTENSIVE FACTOR; INOTROPIC AGENT; MAGNESIUM SULFATE; PHOSPHATE; PHOSPHATE BUFFERED SALINE; SODIUM DIHYDROGEN PHOSPHATE;

ACID BASE BALANCE; ACUTE KIDNEY FAILURE; AGED; ALKALOSIS; ANTICOAGULANT THERAPY; ARTICLE; BIOACCUMULATION; CARDIAC PATIENT; CASE REPORT; CLINICAL EFFECTIVENESS; CLINICAL PROTOCOL; CONTINUOUS HEMOFILTRATION; CONTROLLED STUDY; DEEP VEIN THROMBOSIS; DRUG MEGADOSE; ELECTROLYTE BLOOD LEVEL; FEMALE; HEMODILUTION; HUMAN; HYPOPHOSPHATEMIA; METABOLIC ACIDOSIS; OLIGURIA; PATIENT SAFETY; REGIONAL CITRATE ANTICOAGULATION; SURGICAL PATIENT; THROMBOCYTE COUNT; THROMBOCYTOPENIA; THROMBOSIS PREVENTION;

AGED; ANTICOAGULANTS; CITRIC ACID; FEMALE; FLUID THERAPY; HEMOFILTRATION; HUMANS; PHOSPHATES;

EID: 84875680577     PISSN: 14927535     EISSN: 15424758     Source Type: Journal    
DOI: 10.1111/j.1542-4758.2012.00730.x     Document Type: Article

References (28)

1. Uchino S, Bellomo R, Morimatsu H, etal. Continuous renal replacement therapy: A worldwide practice survey. The beginning and ending supportive therapy for the kidney (B.E.S.T. kidney) investigators. Intensive Care Med. 2007; 33:1563-1570.
2. Morabito S, Pistolesi V, Cibelli L, Pierucci A. Continuous renal replacement therapies (CRRT) will remain the most widely adopted dialysis modality in the critically ill. G Ital Nefrol. 2009; 26:13-21.
3. Prowle JR, Bellomo R. Continuous renal replacement therapy: Recent advances and future research. Nat Rev Nephrol. 2010; 6:521-529.
4. Mehta RL. Anticoagulation during continuous renal replacement therapies. ASAIO J. 1994; 40:931-935.
5. Tan HK, Baldwin I, Bellomo R. Continuous veno-venous hemofiltration without anticoagulation in high-risk patients. Intensive Care Med. 2000; 26:1652-1657.
6. Morabito S, Guzzo I, Solazzo A, Muzi L, Luciani R, Pierucci A. Continuous renal replacement therapies: Anticoagulation in the critically ill at high risk of bleeding. J Nephrol. 2003; 16:566-571.
7. Davenport A, Tolwani A. Citrate anticoagulation for continuous renal replacement therapy (CRRT) in patients with acute kidney injury admitted to the intensive care unit. NDT Plus. 2009; 2:439-447.
8. Oudemans-van Straaten HM, Kellum JA, Bellomo R. Clinical review: Anticoagulation for continuous renal replacement therapy - Heparin or citrate? Crit Care. 2011; 15:202.
9. Morabito S, Pistolesi V, Pierucci A. Regional citrate anticoagulation: Towards a first-choice treatment. G Ital Nefrol. 2012; 29:14-19.
10. Zhang Z, Hongying N. Efficacy and safety of regional citrate anticoagulation in critically ill patients undergoing continuous renal replacement therapy. Intensive Care Med. 2012; 38:20-28.
11. Mariano F, Morselli M, Bergamo D, etal. Blood and ultrafiltrate dosage of citrate as a useful and routine tool during continuous venovenous haemodiafiltration in septic shock patients. Nephrol Dial Transplant. 2011; 26:3882-3888.
12. Fall P, Szerlip HM. Continuous renal replacement therapy: Cause and treatment of electrolyte complications. Semin Dial. 2010; 23:581-585.
13. Tolwani AJ, Campbell RC, Schenk MB, Allon M, Warnock DG. Simplified citrate anticoagulation for continuous renal replacement therapy. Kidney Int. 2001; 60:370-374.
14. Troyanov S, Geadah D, Ghannoum M, Cardinal J, Leblanc M. Phosphate addition to hemodiafiltration solutions during continuous renal replacement therapy. Intensive Care Med. 2004; 30:1662-1665.
15. VA/NIH Acute Renal Failure Trial Network, Palevsky PM, Zhang JH, O'Connor TZ, etal. Intensity of renal support in critically ill patients with acute kidney injury. N Engl J Med. 2008; 359:7-20.
16. RENAL Replacement Therapy Study Investigators, Bellomo R, Cass A, Cole L, etal. Intensity of continuous renal-replacement therapy in critically ill patients. N Engl J Med. 2009; 361:1627-1638.
17. Santiago MJ, López-Herce J, Urbano J, Bellón JM, del Castillo J, Carrillo A. Hypophosphatemia and phosphate supplementation during continuous renal replacement therapy in children. Kidney Int. 2009; 75:312-316.
18. Demirjian S, Teo BW, Guzman JA, etal. Hypophosphatemia during continuous hemodialysis is associated with prolonged respiratory failure in patients with acute kidney injury. Nephrol Dial Transplant. 2011; 26:3508-3514.
19. Broman M, Carlsson O, Friberg H, Wieslander A, Godaly G. Phosphate-containing dialysis solution prevents hypophosphatemia during continuous renal replacement therapy. Acta Anaesthesiol Scand. 2011; 55:39-45.
20. Geerts WH, Bergqvist D, Pineo GF, etal.; American College of Chest Physicians. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th edition). Chest. 2008; 133(Suppl 6):381S-453S.
21. Whitfield LR, Levy G. Permeability of human and rat red blood cells to citrate. Thromb Res. 1981; 21:681-684.
22. Kozik-Jaromin J, Nier V, Heemann U, Kreymann B, Böhler J. Citrate pharmacokinetics and calcium levels during high-flux dialysis with regional citrate anticoagulation. Nephrol Dial Transplant. 2009; 24:2244-2251.
23. Morabito S, Pistolesi V, Tritapepe L, etal. Regional citrate anticoagulation in cardiac surgery patients at high risk of bleeding: A continuous veno-venous hemofiltration protocol with a low concentration citrate solution. Crit Care. 2012; 16:R111.
24. Hetzel GR, Schmitz M, Wissing H, etal. Regional citrate versus systemic heparin for anticoagulation in critically ill patients on continuous venovenous haemofiltration: A prospective randomized multicentre trial. Nephrol Dial Transplant. 2011; 26:232-239.
25. Shum HP, Chan KC, Yan WW. Regional citrate anticoagulation in predilution continuous venovenous hemofiltration using prismocitrate 10/2 solution. Ther Apher Dial. 2012; 16:81-86.
26. Tolwani AJ, Prendergast MB, Speer RR, Stofan BS, Wille KM. A practical citrate anticoagulation continuous venovenous hemodiafiltration protocol for metabolic control and high solute clearance. Clin J Am Soc Nephrol. 2006; 1:79-87.
27. Bugg NC, Jones JA. Hypophosphataemia. Pathophysiology, effects and management on the intensive care unit. Anaesthesia. 1998; 53:895-902.
28. Link A, Klingele M, Speer T, etal. Total-to-ionized calcium ratio predicts mortality in continuous renal replacement therapy with citrate anticoagulation in critically ill patients. Crit Care. 2012; 16:R97.