Nephrol Dial Transplant (2004) 19: 171-178
© ERA–EDTA 2003; all rights reserved
Original Article
Regional citrate anticoagulation in continuous venovenous haemodiafiltration using commercial solutions
1Department of Nephrology, Dialysis and Transplantation, CHU Toulouse-Rangueil and 2Intensive Care Unit, CHU Purpan, Toulouse, France
Correspondence and offprint requests to: Professor Lionel Rostaing, Department of Nephrology, Dialysis and Transplantation, CHU Toulouse-Rangueil, TSA 50032, 31059 Toulouse Cedex 9, France. Email: rostaing.l{at}chu-toulouse.fr The authors wish it to be known that, in their opinion, the first two authors contributed equally to this work.
Background. Treatment with trisodium citrate provides an effective means of regional anticoagulation during continuous renal replacement therapy (CRRT). We evaluated the efficacy, safety and cost of a regional citrate anticoagulation protocol using commercial solutions in 17 critically ill patients treated with continuous venovenous haemodiafiltration (CVVHDF). We performed a total of 22 sessions.
Methods. We delivered an A.C.D-A541® solution containing 112.9 mmol/l disodium citrate (3.22%) at a median rate of 260 (190–280) ml/h via the pre-filter port of a COBE PRISMA with an AN-69 dialyser, while adjusting the rate to maintain post-filtered ionized calcium (iCa2+) between 0.25 and 0.4 mmol/l. Plasma iCa2+ was maintained at >1.1 mmol/l by infusion of calcium chloride at a median rate of 1.70 (1.36–2.27) mmol/h. The dialysate was easily modified according to the acid–base status of each patient. Both replacement and dialysate solutions were delivered at 1200 ml/h. Each session was scheduled for 48 h and biological parameters were assessed every 6 h.
Results. The mean dialyser survival was 39 ± 11 h (median 41.5 h; range 13–48 h). We observed dialyser clotting in four cases (18%). There were no bleeding events or modifications of coagulation parameters. The citrate solution, replacement solution and dialysate were obtained as commercial products. Both the replacement and dialysate solutions contained calcium. The extra cost of this technique was 25 
/day as compared to anticoagulation with heparin.
Conclusions. We designed an efficient method of regional citrate anticoagulation for CVVHDF by using commercial solutions. The monitoring of patients was as intensive as during heparin anticoagulation for CRRT. Because of the higher cost of this method, it should be proposed only for patients with high bleeding risk.
Keywords: bleeding complications; citrate; commercial solutions; critically ill patients; haemodiafiltration; regional anticoagulation
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  A. Davenport and A. Tolwani Citrate anticoagulation for continuous renal replacement therapy (CRRT) in patients with acute kidney injury admitted to the intensive care unit NDT Plus, December 1, 2009; 2(6): 439 - 447. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. D Burry, D. D Tung, D. Hallett, T. Bailie, V. Carvalhana, D. Lee, S. Ramganesh, R. Richardson, S. Mehta, and S. E Lapinsky Regional Citrate Anticoagulation for PrismaFlex Continuous Renal Replacement Therapy Ann. Pharmacother., September 1, 2009; 43(9): 1419 - 1425. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. Cavallini, A. Wieslander, and M. Braide SUBSTITUTING CITRATE FOR LACTATE IN PERITONEAL DIALYSIS FLUID IMPROVES ULTRAFILTRATION IN RATS Perit. Dial. Int., January 1, 2009; 29(1): 36 - 43. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Dirkes and K. Hodge Continuous Renal Replacement Therapy in the Adult Intensive Care Unit: History and Current Trends Crit. Care Nurse, April 1, 2007; 27(2): 61 - 80. [Full Text] [PDF]
|
|
|
|
 |
|
 K. M. Ho Hyperlactataemia induced by CVVHDF with low lactate bicarbonate-buffered solutions in patients with liver dysfunction Nephrol. Dial. Transplant., April 1, 2006; 21(4): 1096 - 1099. [Full Text] [PDF]
|
|
|
|
 |
|
 A. J. Tolwani, M. B. Prendergast, R. R. Speer, B. S. Stofan, and K. M. Wille A Practical Citrate Anticoagulation Continuous Venovenous Hemodiafiltration Protocol for Metabolic Control and High Solute Clearance Clin. J. Am. Soc. Nephrol., January 1, 2006; 1(1): 79 - 87. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. A. Wooley, I. F. Btaiche, and K. L. Good Metabolic and Nutritional Aspects of Acute Renal Failure in Critically Ill Patients Requiring Continuous Renal Replacement Therapy Nutr Clin Pract, April 1, 2005; 20(2): 176 - 191. [Abstract] [Full Text] [PDF]
|
|