Regional citrate anticoagulation in continuous venovenous haemodiafiltration using commercial solutions

Abstract

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.

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

“…Citrate was given in the form of acid citrate dextrose formula-A (ACD-A) solution (Haemonetics, Glasgow, UK; table 1); ACD-A solution is routinely used for anticoagulation of extracorporeal circuits for apheresis and plasma exchange in the UK and for citrate anticoagulated CRRT in Europe and the USA [11,12]. 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).…”

Anticoagulation régionale des circuits extracorporels par le citrate

“…Une concentration d'iCa-patient plus basse (0,9-1,1 mmol/l) est possible si l'affection sous-jacente s'accompagne d'une hypocalcémie (rhabdomyolyse, pancréatite aiguë, hypocalcémie toxique [22]). Les solutions de dialysat ou de dilution ne doivent pas contenir de calcium, au risque de favoriser la thrombose du filtre par réactivation de la coagulation, ou de nécessiter une majoration des doses infusées de citrate, exposant au risque d'accumulation [23,24]. En revanche, les solutions de réinjection peuvent contenir du calcium, mais doivent être réinjectées par la branche veineuse au plus près du patient pour ne pas réacti-ver la coagulation dans le circuit.…”

The Acid-Base Effect of Changing Citrate Solution for Regional Anticoagulation during Continuous Veno-Venous Hemofiltration

“…Regional citrate anticoagulation (RCA) has been used for continuous renal replacement therapy (CR-RT) in patients at high risk of bleeding for more than 15 years (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17). In RCA-CRRT, there are 3 major forms of citrate administration.…”

“…In RCA-CRRT, there are 3 major forms of citrate administration. One is 4% trisodium citrate (2,3,5,6,8,16,17), another is acid citrate dextrose solution (ACD) (11)(12)(13)(14)(15) and a third is citrate containing replacement fluid (4,7,9,10). Recently, a commercial citrate-containing replacement solution was developed for RCA during continuous veno-venous hemofiltration (CVVH) in Australia according to the principles described by Palsson et al (4) and Dorval et al (9) with modification toward a lower citrate concentration (Citrate A; citrate=11mmol/L) (18,19).…”