Regional Citrate Anticoagulation for Continuous Renal Replacement Therapy ‐ A Safe and Effective Low‐Dose Protocol

ABSTRACT Aims Regional citrate anticoagulation (RCA) is the preferred mode of anticoagulation for continuous renal replacement therapy (CRRT). Conventional RCA‐CRRT citrate dose ranges from 3 to 5 mmol/L of blood. This study explored the effectiveness of an RCA protocol with lower citrate dose and i...

Full description

Saved in:
Bibliographic Details
Published in:Nephrology (Carlton, Vic.) Vic.), 2020-04, Vol.25 (4), p.305-313
Main Authors: Poh, Cheng Boon, Tan, Poh Choo, Kam, Jia Wen, Siau, Chuin, Lim, Noelle L, Yeon, Wenxiang, Cui, Hai Hua, Ding, Hai Ting, Song, Xiao Ying, Yan, Peng, Chea, Kai Li, Liu, Jin Shu, Chionh, Chang Yin
Format: Article
Language:English
Subjects:
acute kidney injury
Aged
Anticoagulants - therapeutic use
Blood Coagulation - drug effects
Calcium
citrate
Citric acid
Citric Acid - therapeutic use
Clotting
Continuous Renal Replacement Therapy
critical care
Female
Follow-Up Studies
Humans
Hypocalcemia
Intensive Care Units
Kidney Failure, Chronic - blood
Kidney Failure, Chronic - complications
Kidney Failure, Chronic - therapy
Male
Prospective Studies
regional citrate anticoagulation
Renal replacement therapy
Thrombosis - blood
Thrombosis - etiology
Thrombosis - prevention & control
Treatment Outcome
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:ABSTRACT Aims Regional citrate anticoagulation (RCA) is the preferred mode of anticoagulation for continuous renal replacement therapy (CRRT). Conventional RCA‐CRRT citrate dose ranges from 3 to 5 mmol/L of blood. This study explored the effectiveness of an RCA protocol with lower citrate dose and its impact on citrate‐related complications. Methods This prospective observational study compared two RCA‐CRRT protocols in the intensive care unit. RCA Protocol 1 used an initial citrate dose of 3.0 mmol/L while Protocol 2 started with 2.5 mmol/L. The citrate dose was titrated by sliding scale to target circuit‐iCa 0.26–0.40 mmol/L. Calcium was re‐infused post‐dialyzer and titrated by protocol to target systemic‐iCa 1.01–1.20 mmol/L. Results Two hundred RCA‐CRRT sessions were performed (81 Protocol 1; 119 Protocol 2). The median age was 65.4 years and median APACHE‐II score was 23. Citrate dose for Protocol 1 was significantly higher than Protocol 2 in the first 12 h. The circuit clotting rate was similar in both arms (Protocol 1: 9.9%; Protocol 2: 9.2%; P = 0.881). With Protocol 2, circuit‐iCa levels were 2.42 times more likely to be on target (P = 0.003) while the odds of hypocalcaemia was 4.67 times higher with Protocol 1 (P 
ISSN:1320-5358
1440-1797
DOI:10.1111/nep.13656