A Continuous Veno-Venous Hemofiltration Protocol with Anticoagulant Citrate Dextrose Formula a and a Calcium-Containing Replacement Fluid

Ong, Song; Wille, Keith; Speer, Rajesh; Tolwani, Ashita J.

doi:10.5301/ijao.5000323

Cited by 15 publications

(20 citation statements)

References 5 publications

(5 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…As an advantage over the widely used tri-sodium citrate (TSC) solution, ACD-A has both lower sodium content and less buffer generation after metabolism (2 molecules of bicarbonate per molecule of citrate in comparison with 3 from TSC). ACD-A solution (containing 113 mmol/l citrate) was given to achieve a calculated pre-filter citrate concentration in blood of 2.8 mmol/l [10] (i.e., 2.8/113 = 1/40 of blood flow). This citrate dose, while being lower than in some RCA protocols, has been widely used for safe and effective RCA CRRT, achieving filter iCa 2+ concentrations of around 0.35 mmol/l [10,13], and was felt to represent the best balance between effective anticoagulation and risk of the development of metabolic alkalosis.…”

Section: Methodsmentioning

confidence: 99%

“…In addition to citrate and calcium replacement solutions, calcium-free dialysate or pre-dilution replacement fluid are required to maintain effective anticoagulation during dialysis, hemodiafiltration or pre-dilution hemofiltration, thus increasing the expense and complexity. Conversely in post-dilution hemofiltration, conventional replacement solutions can spare the need for costly supplemental calcium infusions [10]. …”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Implementation of a Simplified Regional Citrate Anticoagulation Protocol for Post-Dilution Continuous Hemofiltration Using a Bicarbonate Buffered, Calcium Containing Replacement Solution

et al. 2016

View full text Add to dashboard Cite

Background/Aims: Recent updates to the Nikkiso Aquarius continuous renal replacement therapy (CRRT) platform allowed us to develop a post-dilution protocol for regional citrate anticoagulation (RCA) using standard bicarbonate buffered, calcium containing replacement solution with acid citrate dextrose formula-A as a citrate source. Our objective was to demonstrate that the protocol was safe and effective. Methods: Prospective audit of consecutive patients receiving RCA for CRRT within intensive care unit, who were either contraindicated to heparin or had poor filter lifespan (<12 h for 2 consecutive filters) on heparin. Results: We present the first 29 patients who used 98 filters. After excluding ‘non-clot' filter loss, 50% had a duration of >27 h. Calcium supplementation was required for 30 (30%) filter circuits, in 17 of 29 (58%) patients. One patient discontinued the treatment due to metabolic alkalosis, but there were no adverse bleeding events. Conclusion: Post-dilution RCA system is effective and simple to use on the Aquarius platform and results in comparable filter life for patients relatively contraindicated to heparin.

show abstract

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Implementation of a Simplified Regional Citrate Anticoagulation Protocol for Post-Dilution Continuous Hemofiltration Using a Bicarbonate Buffered, Calcium Containing Replacement Solution

et al. 2016

View full text Add to dashboard Cite

show abstract

“…Fourth, the calcium fluxes and balances would be different if calcium containing fluid would have been used. There are still units where this modality is applied [32,33] leading to a high dosage of citrate and higher amount of calcium-citrate complexes in effluent. Fifth, the changes of calcium and magnesium might relate to citrate dosages and levels of citrate when analyzing larger cohort of patients.…”

Section: +mentioning

confidence: 99%

Ionized Magnesium and Regional Citrate Anticoagulation for Continuous Renal Replacement Therapy

Zakharchenko¹,

Leden²,

Rulíšek³

et al. 2015

Blood Purif

View full text Add to dashboard Cite

Background: The regional citrate anticoagulation (RCA) induces changes in total (Ca^tot) and ionized (Ca²⁺) calcium. As of now, we do not have much information about parallel changes of total (Mg^tot) and ionized (Mg²⁺) magnesium. Methods: The authors compared changes of Mg²⁺ and Mg^tot with changes of Ca²⁺ and Ca^tot in 32 critically ill patients on 4% trisodium citrate (4% TSC) with calcium-free fluids. Results: The median continuous venovenous hemodiafiltration balance of Mg^tot was -0.91 (-1.18 to -0.53) mmol/h compared to the median balance of Ca^tot 0.86 (0.08-1.55) mmol/h. Postfilter Mg²⁺ decreased by 68.3% (70.8-65.6) in parallel (r = 0.41, p = 0.03) to decrease of postfilter Ca²⁺ (by 70.2% (73.0-66.1)) and was significantly related to the postfilter Ca²⁺ (r = 0.50, p < 0.001). The decrease of prefilter to postfilter Ca²⁺ correlated to a dosage of 4% TSC per blood flow (r = 0.37, p = 0.04). Conclusions: The loss of Mg^tot during RCA is not covered by magnesium concentration in ordinary dialysis/substitution fluid and may lead to the depletion of total body magnesium. The postfilter Mg²⁺ is significantly related to the postfilter Ca²⁺. Video Journal Club “Cappuccino with Claudio Ronco” at http://www.karger.com/?doi = 440972.

show abstract

“…31,38 Generally, because calcium interferes with the action of the citrate, calcium-free dialysate or replacement fluids are often used with citrate anticoagulation. 4 Some researchers, 39,40 however, have shown that citrate anticoagulation can be effective with the use of calcium-containing replacement fluids, eliminating the need for a separate calcium infusion.…”

Section: Wwwccnonlineorgmentioning

confidence: 99%

“…1,31 If citrate is infused as a solution, it can be infused as a mixture of a trisodium citrate solution and an acid-citrate-dextrose solution. 31,39 Whatever the choice of citrate, the citrate dose must be titrated to achieve effective anticoagulation.…”

Section: Wwwccnonlineorgmentioning

confidence: 99%

Continuous Renal Replacement Therapy and Anticoagulation:

Dirkes

Wonnacott

2016

Critical Care Nurse

View full text Add to dashboard Cite

Continuous renal replacement therapy is currently used as a standard treatment for acute kidney injury in the intensive care unit, particularly for patients with unstable hemodynamic status. Because this therapy is continuous, for days or weeks, and the extracorporeal blood circuit is large, the circuit is prone to clotting. Several methods of keeping the extracorporeal circuit patent are available, including heparin infusion, flushes with physiological saline, use of thrombin inhibitors, and citrate. This article reviews methods for continuous renal replacement therapy, anticoagulation, efficacy, and implications for bedside critical care. (Critical Care Nurse. 2016;36[2]:34-42)

show abstract

A Continuous Veno-Venous Hemofiltration Protocol with Anticoagulant Citrate Dextrose Formula a and a Calcium-Containing Replacement Fluid

Abstract: In this pilot study, CVVH using ACD-A for RCA and a Ca2+ -containing RF was safely and effectively used without a continuous Ca2+ infusion. This protocol is a promising solution for maintaining effective CRRT when intravenous calcium is in short supply.

Cited by 15 publications

References 5 publications

Implementation of a Simplified Regional Citrate Anticoagulation Protocol for Post-Dilution Continuous Hemofiltration Using a Bicarbonate Buffered, Calcium Containing Replacement Solution

Implementation of a Simplified Regional Citrate Anticoagulation Protocol for Post-Dilution Continuous Hemofiltration Using a Bicarbonate Buffered, Calcium Containing Replacement Solution

Ionized Magnesium and Regional Citrate Anticoagulation for Continuous Renal Replacement Therapy

Continuous Renal Replacement Therapy and Anticoagulation:

Contact Info

Product

Resources

About