Regional Citrate Anticoagulation for PrismaFlex Continuous Renal Replacement Therapy

Background: Since Mehta et al. reported the first successful use of regional citrate anticoagulation (RCA) for continuous renal replacement therapy (CRRT) in 1990, RCA is increasingly used for CRRT because it provides filter patency with minimal risk of bleeding. However, RCA has been associated wit...

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Bibliographic Details
Published in:The Annals of pharmacotherapy 2009-09, Vol.43 (9), p.1419-1425
Main Authors: Burry, Lisa D, Tung, David D, Hallett, David, Bailie, Toni, Carvalhana, Virginia, Lee, David, Ramganesh, Steve, Richardson, Robert, Mehta, Sangeeta, Lapinsky, Stephen E
Format: Article
Language:English
Subjects:
Acute Kidney Injury - therapy
Adult
Aged
Alkalosis - etiology
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Anticoagulants - administration & dosage
Biological and medical sciences
Calcium Gluconate - administration & dosage
Citric Acid - administration & dosage
Critical Illness
Emergency and intensive care: renal failure. Dialysis management
Female
Glucose - administration & dosage
Glucose - analogs & derivatives
Hospitals, University
Humans
Hypocalcemia - etiology
Intensive care medicine
Intensive Care Units
Male
Medical sciences
Middle Aged
Pharmacology. Drug treatments
Renal Replacement Therapy - adverse effects
Renal Replacement Therapy - methods
Retrospective Studies
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Summary:Background: Since Mehta et al. reported the first successful use of regional citrate anticoagulation (RCA) for continuous renal replacement therapy (CRRT) in 1990, RCA is increasingly used for CRRT because it provides filter patency with minimal risk of bleeding. However, RCA has been associated with significant metabolic complications including hypocalcemia, hypernatremia, metabolic alkalosis, and citrate toxicity. Objective: To describe our experience with a newly implemented RCA protocol with acid citrate dextrose formula A (ACD-A) and intravenous calcium gluconate, for use with PrismaFlex CRRT in critically ill patients with acute kidney injury. Methods: A retrospective chart review was conducted from May 1, 2006, until May 1, 2007, in a 16-bed medical-surgical university-affiliated intensive care unit. Data collected included dialysis filter life, patient and circuit metabolic parameters, and units of packed red blood cells transfused. Results: Forty-eight patients received dialysis with citrate (n = 178 fitters). Circuit clotting occurred in 24% of all filters. Mean ± SD filter life was 38.4 ± 25.9 hours, and filter survival at 48 hours was 38.2%. Persistent metabolic alkalosis while on CRRT was identified in 6 of 45 (13.3%) patients. Mild hypocalcemia (ionized calcium
ISSN:1060-0280
1542-6270
DOI:10.1345/aph.1M182