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Regional Citrate Anticoagulation

Anna Sidoti, Etrusca Brogi, Joshua Morse, Michele Collareta, Luigi Vetrugno, Francesco Giunta, Francesco Forfori
Direct hemoperfusion with polymyxin B (PMX-DHP) is an extracorporeal treatment to add to conventional therapy during unresponsive endotoxic septic shock. So far, only heparin has been used as an anticoagulant during polymyxin B therapy. We present a case report of a postsurgical septic patient treated with 2 cycles of PMX-DHP using citrate anticoagulation. Monitoring of serum calcium, postcartridge calcium, and acid-base balance was performed. The treatments were accomplished without complications. To our knowledge, this is the first published report on the use of citrate anticoagulation during PMX-DHP...
September 23, 2016: A & A Case Reports
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
Rita Jacobs, Patrick M Honore, Marc Diltoer, Herbert D Spapen
BACKGROUND: Citrate, the currently preferred anticoagulant for continuous veno-venous hemofiltration (CVVH), may influence acid-base equilibrium. METHODS: The effect of 2 different citrate solutions on acid-base status was assessed according to the Stewart-Figge approach in two consecutive cohorts of critically ill adult patients. The first group received Prismocitrate 10/2 (PC10/2; 10 mmol citrate/L). The next group was treated with Prismocitrate 18/0 (PC18; 18 mmol citrate/L)...
2016: BMC Nephrology
Rita Jacobs, Patrick M Honore, Inne Hendrickx, Herbert D Spapen
No abstract text is available yet for this article.
2016: Blood Purification
P K C Janssen, N A Foudraine, D M T Burgers, C Neef, J L M L le Noble
INTRODUCTION: Cefuroxime is frequently prescribed as an antimicrobial therapy in critically ill patients. The aim of this study was to develop a new intravenous dosing strategy for cefuroxime in critically ill patients undergoing continuous venovenous hemofiltration with regional citrate anticoagulation (RCA-CVVH) by analyzing its extracorporeal removal and pharmacokinetic (PK) parameters. METHODS: Nine critically ill patients treated with intravenous cefuroxime and RCA-CVVH and a phosphate-containing replacement fluid were investigated...
August 4, 2016: Therapeutic Drug Monitoring
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
Tomáš Zaoral, Michal Hladík, Jana Zapletalová, Bořek Trávníček, Eliška Gelnarová
OBJECTIVES: To determine if there is a difference between regional citrate and global heparinized anticoagulation on circuit lifetimes during continuous venovenous hemodialysis in children. DESIGN: Prospective "cross-over" trial. SETTING: PICU, Department of Pediatrics, University Hospital Ostrava. PATIENTS: Children 0-18 years old. INTERVENTIONS: From 2009 to 2014, 63 eligible children (age, 89...
September 2016: Pediatric Critical Care Medicine
De-Lin Liu, Li-Feng Huang, Wen-Liang Ma, Qi Ding, Yue Han, Yue Zheng, Wen-Xiong Li
BACKGROUND: It is unclear that how to decide the calcium infusion rate during continuous veno-venous hemofiltration (CVVH) with regional citrate anticoagulation (RCA). This study aimed to assess the determinants of calcium infusion rate during CVVH with RCA in critically ill patients with acute kidney injury (AKI). METHODS: A total of 18 patients with AKI requiring CVVH were prospectively analyzed. Postdilution CVVH was performed with a fixed blood flow rate of 150 ml/min and a replacement fluid flow rate of 2000 ml/h for each new circuit...
July 20, 2016: Chinese Medical Journal
R Lakshmi, K K Jayavardhanan, T V Aravindakshan
AIM: To analyze the promoter sequence of toll-like receptor (TLR) genes in Vechur cattle, an indigenous breed of Kerala with the sequence of Bos taurus and access the differences that could be attributed to innate immune responses against bovine mastitis. MATERIALS AND METHODS: Blood samples were collected from Jugular vein of Vechur cattle, maintained at Vechur cattle conservation center of Kerala Veterinary and Animal Sciences University, using an acid-citrate-dextrose anticoagulant...
June 2016: Veterinary World
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
Andreja Marn Pernat, Bojan Medved, Jakob Gubenšek, Vladimir Premru, Bojan Knap, Jadranka Buturovic-Ponikvar, Rafael Ponikvar
We proposed a combination of convective and diffusive transport mechanisms as high cut-off (HCO) post-dilution hemodiafiltration dialysis technique to optimize serum immunoglobulin free light chains (FLCs) removal which may improve dialysis dependent renal failure in patients with multiple myeloma. To reduce bleeding risk regional citrate anticoagulation was successfully used for the first 7 h followed by 1 h anticoagulant-free hemodiafiltration to avoid citrate accumulation. We retrospectively assessed the effect of FLCs reduction on the renal outcome of 28 patients treated with 133 citrate extended post-dilution HCO (Theralite 2100; Gambro, Lund, Sweden) hemodiafiltration sessions between 2010 and 2016...
June 2016: Therapeutic Apheresis and Dialysis
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
E Burford, E Walter, A Beverly
No abstract text is available yet for this article.
December 2015: Intensive Care Medicine Experimental
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
Richard F Singer, Oliver Williams, Chari Mercado, Bonny Chen, Girish Talaulikar, Giles Walters, Darren M Roberts
BACKGROUND: Regional citrate hemodialysis anticoagulation is used when heparin is contraindicated, but most protocols require large infusions of calcium and frequent intradialytic plasma ionized calcium measurements. OBJECTIVES: The objective of this study was to determine the safety, efficacy, and effect on calcium balance of regional citrate anticoagulation using sparse plasma ionized calcium sampling. DESIGN: The design of this study was observational...
2016: Canadian Journal of Kidney Health and Disease
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
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