The Effects of a Novel Calcium-Free Lactate Buffered Dialysis and Substitution Fluid for Regional Citrate Anticoagulation - Prospective Feasibility Study

Abstract

Background: Testing metabolic effects of a novel calcium-free, magnesium, phosphate and lactate containing solution (Lactocitrate) in combination with citrate anticoagulation. Methods: Patients on CRRT (2,000 ml/h, blood flow (Qb) 100 ml/min, trisodium citrate (4% TSC)) with arterial lactate <3 mmol/l were included. At start, bicarbonate-buffered fluid was changed to Lactocitrate and the substitution of magnesium and phosphorus ceased. At 9 h the Qb was increased to 150 ml/min. At 18 h the CRRT dosage was increased to 3,000 ml/h. Results: In 22 CVVHDF patients and another 23 on CVVH the pH, aHCO₃ and Na (all p > 0.05) showed no significant changes regardless of the increased dosage of 4% TSC at 9 h (p < 0.001). Mg_tot and phosphorus stabilised within normal range. Arterial lactate increased to 1.9 (1.6-2.6) mmol/l at 3,000 ml/h, p < 0.001). Citrate- and lactate-related energetic gains were up to 74 (61-86) kJ/h. Conclusions: The fluid performed well within ordinary CRRT dosage and Qb up to 150 ml/min. Lactate levels mildly increased and no magnesium and phosphorus replenishments were necessary.

The Effects of High Level Magnesium Dialysis/Substitution Fluid on Magnesium Homeostasis under Regional Citrate Anticoagulation in Critically Ill

“…The research was performed as a single center prospective 27h sequential exposure cohort study at 20 bed ICU of University Hospital [ 21 ]. The study received approval from the Ethics Committee of the General University Hospital, written informed consent was obtained from next of kin.…”

“…The magnesium balances when using newly designed original calcium-free high magnesium (1.50 mmol/l) containing solution for RCA [ 21 ] were compared to the RCA with ordinary calcium-free fluid containing 0.75 mmol/l of magnesium. As part of the registered research project on metabolic impact of regional citrate anticoagulation (NCT01361581) the authors had developed a novel lactate based fluid [ 21 ] and later commenced with its routine use. The novel fluid with high level of magnesium has become a part of standard patient care.…”

“…In our research we developed and tested novel fluid for RCA containing high level magnesium [ 21 ]. Our hypothesis was that the amount of magnesium in commonly used dialysis/substitution fluids should be supranormal for application with citrate modality in the intensive care setting.…”

A Rare Case of Severe Metabolic Alkalosis with Unusual Hyperproteinemia Treated with Continuous Renal Replacement Therapy and Regional Citrate Anticoagulation

“…10$ calcium chloride continuous infusion starts at 10 mL/h and is then titrated to maintain arterial ionised calcium between 0.85 and 1.2 mmol/L. The default dialysis/replacement fluid is the calcium-free lactate-buffered solution Lactocitrate Ⓡ (GML, Czech Republic) [2]. …”

“…The applied model of blood flow around 90–110 mL/min enables “flow-limited dialysis” on a large-area filter [2, 3, 4, 5]. The calcium-citrate complex is partly dialysed (35–40$) [4] and partly metabolised in the liver and other tissues producing bicarbonate.…”