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Maria Huguet, Lida Rodas, Miquel Blasco, Luis F Quintana, Jordi Mercadal, Jose T Ortiz-Pérez, Irene Rovira, Esteban Poch
BACKGROUND: Regional citrate anticoagulation (RCA) is being used increasingly in continuous renal replacement therapy (CRRT) as a safer alternative to heparin. However, complex metabolic control to avoid side effects have generated discrepancies about its introduction into everyday practice. We aimed to compare both anticoagulation techniques in terms of efficacy, safety and feasibility. METHODS: Observational retrospective study performed in 3 specialized ICUs in patients receiving CVVHDF with RCA between January 2013 and May 2016...
November 24, 2017: International Journal of Artificial Organs
Valentina Pistolesi, Laura Zeppilli, Francesca Polistena, Maria Itala Sacco, Alessandro Pierucci, Luigi Tritapepe, Giuseppe Regolisti, Enrico Fiaccadori, Santo Morabito
AIMS: To evaluate the efficacy and safety of a commercially available phosphate-containing solution for continuous renal replacement therapy (CRRT) in preventing CRRT-related hypophosphatemia. METHODS: In heart surgery patients undergoing continuous veno-venous haemodiafiltration (CVVHDF) with regional citrate anticoagulation (RCA), we combined an 18 mmol/l citrate solution with a phosphate-containing (1.2 mmol/l) dialysate/replacement fluid evaluating the incidence of hypophosphatemia and the need for parenteral phosphorus supplementation...
2017: Blood Purification
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...
May 13, 2016: Critical Care: the Official Journal of the Critical Care Forum
Martin Balik, Michael Zakharchenko, Pavel Leden, Michal Otahal, Jan Rulisek, Helena Brodska, Martin Stritesky
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...
2014: Blood Purification
Ilse Gradwohl-Matis, Michael Franzen, Christina Seelmaier, Andreas Brunauer, Daniel Dankl, Martin W Dünser, Hermann Salmhofer
Hemodialysis is considered the renal replacement technique of choice to control life-threatening hypercalcemia. In this case series, the experience with continuous venovenous hemodiafiltration (CVVHDF) with regional citrate anticoagulation to control five hypercalcemic crises in four patients is summarized. Overall maximum ionized and total calcium levels ranged from 1.72 to 2.01 mmol/L and 3.1 to 4.2 mmol/L, respectively. All patients presented with impaired consciousness, cardiac arrhythmias, or acute oliguria, despite therapy...
March 2015: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Jochen Gille, Armin Sablotzki, Michael Malcharek, Thomas Raff, Martin Mogk, Torsten Parentin
INTRODUCTION: For critically ill patients, the use of regional citrate anticoagulation as part of continuous renal replacement therapy (CRRT) has become increasingly common in recent years. However, there are scarce data on the use of this technique in patients with burns. The aim of this study was to examine the effectiveness, feasibility and complications of regional citrate anticoagulation for CRRT in burn patients, as well as the effects on coagulation and the electrolyte and acid-base balance...
December 2014: Burns: Journal of the International Society for Burn Injuries
Santo Morabito, Valentina Pistolesi, Luigi Tritapepe, Elio Vitaliano, Laura Zeppilli, Francesca Polistena, Enrico Fiaccadori, Alessandro Pierucci
BACKGROUND: Recent guidelines suggest the adoption of regional citrate anticoagulation (RCA) as first choice CRRT anticoagulation modality in patients without contraindications for citrate. Regardless of the anticoagulation protocol, hypophosphatemia represents a potential drawback of CRRT which could be prevented by the adoption of phosphate-containing CRRT solutions. The aim was to evaluate the effects on acid-base status and phosphate supplementation needs of a new RCA protocol for Continuous Venovenous Hemodiafiltration (CVVHDF) combining the use of citrate with a phosphate-containing CRRT solution...
October 25, 2013: BMC Nephrology
Matthew Brain, Mike Anderson, Scott Parkes, Peter Fowler
OBJECTIVE: To describe magnesium flux and serum concentrations in ICU patients receiving continuous venovenous haemodiafiltration (CVVHDF). DESIGN: Samples were collected from 22 CVVHDF circuits using citrate anticoagulation solutions (Prismocitrate 10/2 and Prism0cal) and from 26 circuits using Hemosol B0 and heparin anticoagulation. CVVHDF prescription, magnesium supplementation and anticoagulation choice was by the treating intensivist. We analysed 334 sample sets consisting of arterial, prefilter and postfilter blood and effluent...
December 2012: Critical Care and Resuscitation: Journal of the Australasian Academy of Critical Care Medicine
Martin Balik, Mykhaylo Zakharchenko, Pavel Leden, Michal Otahal, Jan Hruby, Ferdinand Polak, Katerina Rusinova, Zdenek Stach, Monika Tokarik, Jaroslava Vavrova, Antonin Jabor, Heleen M Oudemans-van Straaten
PURPOSE: To determine bioenergetic gain of 2 different citrate anticoagulated continuous hemodiafiltration (CVVHDF) modalities and a heparin modality. MATERIALS AND METHODS: We compared the bio-energetic gain of citrate, glucose and lactate between 29 patients receiving 2.2% acid-citrate-dextrose with calcium-containing lactate-buffered solutions (ACD/Ca(plus)/lactate), 34 on 4% trisodium citrate with calcium-free low-bicarbonate buffered fluids (TSC/Ca(min)/bicarbonate), and 18 on heparin with lactate buffering (Hep/lactate)...
February 2013: Journal of Critical Care
Rolando Claure-Del Granado, Etienne Macedo, Glenn M Chertow, Sharon Soroko, Jonathan Himmelfarb, T Alp Ikizler, Emil P Paganini, Ravindra L Mehta
PURPOSE: There is no consensus on the optimal method to measure delivered dialysis dose in patients with acute kidney injury (AKI). The use of direct dialysate-side quantification of dose in preference to the use of formal blood-based urea kinetic modeling and simplified blood urea nitrogen (BUN) methods has been recommended for dose assessment in critically-ill patients with AKI. We evaluate six different blood-side and dialysate-side methods for dose quantification. METHODS: We examined data from 52 critically-ill patients with AKI requiring dialysis...
June 2012: International Journal of Artificial Organs
Martin Balik, Mykhaylo Zakharchenko, Michal Otahal, Jan Hruby, Ferdinand Polak, Katerina Rusinova, Zdenek Stach, Jaroslava Vavrova, Antonin Jabor
BACKGROUND: There are limited data on systemic delivery of metabolic substrates during citrate anticoagulation. The direct citrate measurements are usually not available. METHODS: Patients on 2.2% acid-citrate-dextrose (ACD, n = 41) were compared to a control group on unfractionated heparin (n = 17). All were treated on 1.9-m(2) polysulfone filters. Samples were taken from the central venous catheter, ports pre- and post-filter and from effluent. RESULTS: The gain of citrate in CVVH (n = 18) was not different from CVVHDF (n = 23, p = 0...
2012: Blood Purification
Filippo Mariano, Maurizio Morselli, Daniela Bergamo, Zsuzsanna Hollo, Sandro Scella, Mariella Maio, Ciro Tetta, Ambrogio Dellavalle, Maurizio Stella, Giorgio Triolo
BACKGROUND: Citrate anticoagulation is gaining popularity in renal replacement therapies (RRT) for critically ill patients. In order to study whether citrate accumulates in septic shock patients, we determined citrate in plasma and dialysate during continuous venovenous haemodiafiltration (CVVHDF). METHODS: An automated routine determination of citrate was set up using a commercial kit (citrate lyase method). Twelve patients with septic shock on CVVHDF and citrate anticoagulation were studied ex vivo for citrate levels in systemic and circuit blood and in the ultrafiltrate (at 0, 0...
December 2011: Nephrology, Dialysis, Transplantation
Rolando Claure-Del Granado, Etienne Macedo, Glenn M Chertow, Sharon Soroko, Jonathan Himmelfarb, T Alp Ikizler, Emil P Paganini, Ravindra L Mehta
BACKGROUND AND OBJECTIVES: Studies examining dose of continuous renal replacement therapy (CRRT) and outcomes have yielded conflicting results. Most studies considered the prescribed dose as the effluent rate represented by ml/kg per hour and reported this volume as a surrogate of solute removal. Because filter fouling can reduce the efficacy of solute clearance, the actual delivered dose may be substantially lower than the observed effluent rate. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Data were examined from 52 critically ill patients with acute kidney injury (AKI) requiring dialysis...
March 2011: Clinical Journal of the American Society of Nephrology: CJASN
Filippo Mariano, Luisa Tedeschi, Maurizio Morselli, Maurizio Stella, Giorgio Triolo
PURPOSE: Anticoagulation during renal replacement therapy remains an important challenge for burn patients due to their high risk of bleeding. In this study we compared the efficacy and safety of citrate anticoagulation to heparin anticoagulation for hemodiafiltration (HDF) in severe burn patients, focusing on metabolic tolerance and handling of citrate. METHODS: Retrospective observational study (January 2000-December 2007) at a university teaching hospital. Among 548 patients admitted with burns, 70 severe burn septic shock patients (median age 57...
October 2010: Intensive Care Medicine
Rosilene Motta Elias, Américo Cuvello-Neto, Maristela Carvalho da Costa
Infections with Histoplasma are rarely seen in immunocompromized patients. We report the case of a renal transplant recipient who presented with disseminated histoplasmosis 3.5 years after transplant. He presented severe lactic acidosis (LA), sepsis complicated by circulatory failure, renal failure, and liver dysfunction. We describe the successful use of continuous venovenous hemodiafiltration (CVVHDF) with regional citrate anticoagulation, treatment that stabilized our patient until infectious focus was identified and treated...
January 2009: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Hugh Davies, David Morgan, Gavin Leslie
BACKGROUND: The use of citrate to anticoagulate the Continuous Renal Replacement Therapy (CRRT) circuit has not been widely adopted in Australia as an alternative to heparin due to treatment complexity and risks of metabolic complications and availability of suitable solutions. However, interest persists in citrate anticoagulation as a viable alternative when heparin is either contraindicated or has failed to provide an adequate circuit lifespan due to dialyser clotting. AIM: This paper will describe a regional citrate anticoagulation protocol based on the 'Alabama Protocol' (AP) for pre-dilutional continuous veno-venous haemodiafiltration (CVVHDf) adapted to meet local requirements of an Australian tertiary medical-surgical intensive care unit...
August 2008: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
Kamila Polanská, Karel Opatrný, Richard Rokyta, Ales Krouzecký, Ladislav Vit, Eduard Kasal
This study was designed to assess the principal markers of thrombogenicity and biocompatibility during continuous veno-venous hemodiafiltration (CVVHDF) using regional citrate anticoagulation (RCA). In a prospective study, 11 procedures with a polysulfone membrane were performed in nine critically ill patients with acute renal failure and impaired hemostasis. Blood samples were taken before and during CVVHDF at diafilter outlet--before calcium-induced reversal of the effect of citrate--at 15, 60, 360, and 1440 minutes...
2006: Renal Failure
Kevin W Finkel, John R Foringer
BACKGROUND: Sustained low efficiency dialysis (SLED) is a hybrid therapy that uses a conventional hemodialysis machine to deliver lower solute clearance over prolonged periods of time, typically 8 to 12 hours per treatment, and utilizes the same sodium and bicarbonate concentrations as intermittent hemodialysis. The therapy has been shown to be an effective dialysis mode for the critically ill patient with acute renal failure and hemodynamic instability. At our institution, critically ill patients requiring renal replacement therapy receive SLED on a continuous, 24-hour schedule (C-SLED)...
2005: Renal Failure
Monika Gupta, Nand K Wadhwa, Rose Bukovsky
BACKGROUND: Regional anticoagulation with trisodium citrate for continuous venovenous hemodiafiltration (CVVHDF) is an effective and safe alternative to heparin, especially in patients at high risk for bleeding. However, regional citrate anticoagulation is not used widely because current protocols are complex, labor intensive, and cumbersome. Existing protocols require the use of calcium-free dialysate with a continuous systemic calcium infusion to prevent hypocalcemia. We evaluated Anticoagulant Citrate Dextrose Formula A (ACD-A) solution for regional anticoagulation in CVVHDF in combination with a commercially available calcium-containing dialysis solution...
January 2004: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Olivier Cointault, Nassim Kamar, Pierre Bories, Laurence Lavayssiere, Olivier Angles, Lionel Rostaing, Michèle Genestal, Dominique Durand
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-A(541(R)) solution containing 112...
January 2004: Nephrology, Dialysis, Transplantation
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