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citrate renal replacement therapy

Charlotte Trumper
Continuous renal replacement therapy (CRRT) is widely used in the management of critically ill patients with acute kidney injury. It requires effective anticoagulation of the extracorporeal blood circuit. Although heparin is the most commonly prescribed anticoagulant, there are issues associated with heparin, and there has been increasing interest in regional citrate anticoagulation as an alternative. In 2013, The Leeds Teaching Hospitals NHS Trust switched from heparin to citrate anticoagulant for CRRT in intensive care units (ICUs) across the Trust...
September 8, 2016: British Journal of Nursing: BJN
Timothy E Bunchman
No abstract text is available yet for this article.
September 2016: Pediatric Critical Care Medicine
Rita Jacobs, Patrick M Honore, Inne Hendrickx, Herbert D Spapen
No abstract text is available yet for this article.
2016: Blood Purification
Paul D'Orazio, Helen Visnick, Shankar Balasubramanian
BACKGROUND: Variable ionized calcium measurements in post filter blood samples during continuous renal replacement therapy (renal dialysis) using regional citrate anticoagulation (RCA) have been reported using commercial blood gas analyzers, resulting in analyzer-dependent differences in decisions regarding adjustment of citrate dose. METHODS: We evaluated accuracy for measurement of iCa at low concentrations by 4 commercial blood gas analyzers using primary reference solutions formulated down to 0...
October 1, 2016: Clinica Chimica Acta; International Journal of Clinical Chemistry
Mychajlo Zakharchenko, Ferdinand Los, Helena Brodska, Martin Balik
BACKGROUND: The requirements for magnesium (Mg) supplementation increase under regional citrate anticoagulation (RCA) because citrate acts by chelation of bivalent cations within the blood circuit. The level of magnesium in commercially available fluids for continuous renal replacement therapy (CRRT) may not be sufficient to prevent hypomagnesemia. METHODS: Patients (n = 45) on CRRT (2,000 ml/h, blood flow (Qb) 100 ml/min) with RCA modality (4% trisodium citrate) using calcium free fluid with 0...
2016: PloS One
Chris Anstey, Victoria Campbell, Alexander Richardson
BACKGROUND/AIMS: The study aimed to compare the changes in biochemistry occurring in patients undergoing continuous renal replacement therapy (CRRT) using 2 trisodium citrate solutions, Baxter hemofiltration fluid containing 18 mmol/l (C18) and Baxter NamSol, a custom manufactured solution containing 15 mmol/l (C15), both delivered as regional citrate anticoagulation (RCA) predilution fluids for hemofiltration. METHODS: This is a prospective randomized control trial conducted in a major regional adult intensive care unit...
2016: Blood Purification
Jadranka Buturovic-Ponikvar
Citrate has many characteristics of the ideal anticoagulant for hemodialysis. In addition to immediate and complete anticoagulation in the dialysis circuit, citrate has important effects beyond anticoagulation, mainly in reducing inflammatory response induced by hemodialysis. Citrate has already become the standard anticoagulant in acute kidney injury requiring continuous renal replacement therapy (CRRT), both for adults and children, with the citrate module being a part of modern CRRT monitors. Although the citrate module is not yet available for intermittent hemodialysis, precise infusion pumps, point-of-care ionometers and high citrate clearance from high flux dialyzers increase safety while reducing the risk of metabolic complications, both in adult and pediatric patients...
June 2016: Therapeutic Apheresis and Dialysis
Marjorie Houllé-Veyssière, Audrey Courtin, Norddine Zeroual, Philippe Gaudard, Pascal H Colson
OBJECTIVES: To evaluate the nursing workload related to two techniques of continuous renal replacement therapy. RESEARCH METHODOLOGY: We analysed retrospectively the nursing work load caused directly by continuous renal replacement therapy in a cohort of patients admitted consecutively over 10 months. Two types of continuous renal replacement therapy have been compared: dialysis with regional citrate anticoagulation and haemodiafiltration with systemic heparin coagulation...
October 2016: Intensive & Critical Care Nursing: the Official Journal of the British Association of Critical Care Nurses
Rob Wonnacott, Brandi Josephs, Jill Jamieson
Regional citrate for continuous renal replacement therapy (CRRT) use in patients with liver failure or post-liver transplant has been considered a contraindication because of the risk of citrate toxicity development. Regional citrate has the benefit of decreased bleeding risks over systemic anticoagulation; therefore, it is of great benefit to the coagulopathic and surgical populations. This article analyzes current empiric data and compares with a case study specifically related to liver failure, liver transplant, and CRRT use...
July 2016: Critical Care Nursing Quarterly
Chao Liu, Zhi Mao, Hongjun Kang, Jie Hu, Feihu Zhou
BACKGROUND: Regional citrate or heparin is often prescribed as an anticoagulant for continuous renal replacement therapy (CRRT). However, their efficacy and safety remain controversial. Therefore, we performed this meta-analysis to compare these two agents and to determine whether the currently available evidence is sufficient and conclusive by using trial sequential analysis (TSA). METHODS: We searched for relevant studies in PubMed, Embase, the Cochrane Library databases and the China National Knowledge Infrastructure (CNKI) Database from database inception until September 2015...
2016: Critical Care: the Official Journal of the Critical Care Forum
Ondřej Zuščich, Roman Hájek, Pavel Ševčík, Vladimír Lonský, Jana Zapletalová
INTRODUCTION: This work is focused on mapping issues of hemostasis in patients during continuous renal replacement therapy, or the possible impact of the use of anticoagulants. METHODS: The study included 30 consecutive patients requiring continuous renal replacement therapy following cardiac surgery in the period of 2009 to 2012. Patients were placed into 2 branches according to the selected method of anticoagulation (regional citrate anticoagulation-RCA, unfractionated heparin UFH)...
May 16, 2016: International Journal of Artificial Organs
Nithin Karakala, Ashita Tolwani
Continuous Renal Replacement Therapy (CRRT) usually requires anticoagulation to prevent clotting of the extracorporeal circuit. Interruptions due to filter clotting significantly reduce total therapy time and CRRT efficacy. Although heparin has traditionally been the most common anticoagulant used for CRRT, increasing evidence suggests that heparin is less effective than regional citrate in prolonging circuit life and considerably increases patient bleeding risk. Advantages of regional citrate anticoagulation (RCA) include less bleeding, increased circuit life, and less blood transfusion requirement...
July 2016: Seminars in Dialysis
Susan Dirkes, Rob Wonnacott
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...
April 2016: Critical Care Nurse
Mychajlo Zakharchenko, Pavel Leden, Jan Rulíšek, Ferdinand Los, Helena Brodska, Martin Balik
BACKGROUND: The regional citrate anticoagulation (RCA) induces changes in total (Catot) and ionized (Ca2+) calcium. As of now, we do not have much information about parallel changes of total (Mgtot) and ionized (Mg2+) magnesium. METHODS: The authors compared changes of Mg2+ and Mgtot with changes of Ca2+ and Catot in 32 critically ill patients on 4% trisodium citrate (4% TSC) with calcium-free fluids. RESULTS: The median continuous venovenous hemodiafiltration balance of Mgtot was -0...
2016: Blood Purification
John S Thurlow, Christina M Yuan
Intradialytic hypotension is the most common complication associated with hemodialysis. We describe a case of severe intradialytic hypotension during routine chronic dialysis, the presenting symptom of hypocalcemia due to a procedural error involving a zero calcium liquid acid dialysate concentrate. Although human factors were the root cause of this event, we discuss physical and procedural controls that may help to minimize the risk of human error. Citrate anticoagulation for renal replacement therapy is increasingly used, particularly in acute kidney injury...
April 2016: Hemodialysis International
David Gutierrez-Bernays, Matthew Ostwald, Chris Anstey, Victoria Campbell
Regional citrate anticoagulation (RCA) for continuous renal replacement therapy (CRRT) has recently been recommended as first-line over heparin. Evidence suggests that RCA prolongs filter life and may reduce bleeding risk, but there is little research on the benefits to dialysis dose delivery or cost, or the effectiveness of transitioning to RCA first-line. The aim of the present study was to assess the effect on dialysis delivery, cost and safety when transitioning from systemic heparin to RCA for first-line anticoagulation for CRRT...
February 2016: Therapeutic Apheresis and Dialysis
Norio Hanafusa
BACKGROUND: Continuous renal replacement therapy (CRRT) is performed mainly in patients with acute kidney injury, severe sepsis, or septic shock. Evidence has emerged about the indications for and therapeutic conditions of CRRT. In this review, we focus on the evidence for CRRT to date. SUMMARY: CRRT employs diffusion, convection and adsorption to remove solutes from plasma. Indications can be divided into renal and non-renal indications. Concrete renal indications have not yet been determined, except for life-threatening absolute indications...
2015: Blood Purification
Heleen M Oudemans-van Straaten, Marlies Ostermann
Citrate has been recommended as the first-line anticoagulant for continuous renal replacement therapy (CRRT) in critically ill patients. Compared with heparin, citrate anticoagulation is safer and more efficacious. Citrate inhibits the coagulation cascade by lowering the ionized calcium (iCa) concentration in the filter. Monitoring of systemic iCa concentrations is inherent to the protocol, and monitoring of postfilter iCa is recommended to adjust citrate flow and optimize anticoagulation. While systemic iCa targets are in the physiological range, postfilter iCa concentrations are targeted between 0...
December 4, 2015: Critical Care: the Official Journal of the Critical Care Forum
Patrick M Honore, Rita Jacobs, Inne Hendrickx, Elisabeth De Waele, Viola Van Gorp, Herbert D Spapen
No abstract text is available yet for this article.
2015: Critical Care: the Official Journal of the Critical Care Forum
Ming Bai, Meilan Zhou, Lijie He, Feng Ma, Yangping Li, Yan Yu, Pengbo Wang, Li Li, Rui Jing, Lijuan Zhao, Shiren Sun
PURPOSE: The purpose of this study was to evaluate the effect and safety of citrate versus heparin anticoagulation for continuous renal replacement therapy (CRRT) in critically ill patients by performing a meta-analysis of updated evidence. METHODS: Medline, Embase, and Cochrane databases were searched for eligible studies, and manual searches were also performed to identify additional trials. Randomized controlled trials (RCTs) assessing the effect of citrate versus heparin anticoagulation for CRRT were considered eligible for inclusion...
December 2015: Intensive Care Medicine
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