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Regional Citrate Anticoagulation

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https://www.readbyqxmd.com/read/29324487/renal-replacement-therapy-in-critically-ill-patients-who-when-why-and-how
#1
Melanie Meersch, Alexander Zarbock
PURPOSE OF REVIEW: The increasing incidence of acute kidney injury has the immediate effect of a growing need for renal replacement therapy (RRT). Shedding light on the questions of who, when, why, and how RRT should be performed is difficult to accomplish because of ambiguous study results, poor quality evidence, and low standardization. RECENT FINDINGS: Critically ill patients are exposed to multiple factors known to deteriorate kidney function. Especially severe fluid overload is strongly associated with worse outcome and may be considered as a trigger for initiating RRT...
January 10, 2018: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/29248145/renal-replacement-therapy-and-anticoagulation
#2
REVIEW
Timo Brandenburger, Thomas Dimski, Torsten Slowinski, Detlef Kindgen-Milles
Today, up to 20% of all intensive care unit patients require renal replacement therapy (RRT), and continuous renal replacement therapies (CRRT) are the preferred technique. In CRRT, effective anticoagulation of the extracorporeal circuit is mandatory to prevent clotting of the circuit or filter and to maintain filter performance. At present, a variety of systemic and regional anticoagulation modes for CRRT are available. Worldwide, unfractionated heparin is the most widely used anticoagulant. All systemic techniques are associated with significant adverse effects...
September 2017: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/29187232/long-term-continuous-renal-replacement-therapy-and-anticoagulation-with-citrate-in-critically-ill-patients-with-severe-liver-dysfunction
#3
Matthias Klingele, Theresa Stadler, Danilo Fliser, Timo Speer, Heinrich V Groesdonk, Alexander Raddatz
BACKGROUND: As of 2009, anticoagulation with citrate was standard practice in continuous renal replacement therapy (CRRT) for critically ill patients at the University Medical Centre of Saarland, Germany. Partial hepatic metabolism of citrate means accumulation may occur during CRRT in critically ill patients with impaired liver function. The aim of this study was to evaluate the actual influence of hepatic function on citrate-associated complications during long-term CRRT. METHODS: In a retrospective study conducted between January 2009 and November 2012, all cases of dialysis therapy performed in the interdisciplinary surgical intensive care unit were analysed...
November 29, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29185591/safety-and-efficacy-of-regional-citrate-anticoagulation-in-continuous-blood-purification-treatment-of-patients-with-multiple-organ-dysfunction-syndrome
#4
B Tuerdi, L Zuo, H Sun, K Wang, Z Wang, G Li
The aim of this study was to discuss the safety and efficacy of regional citrate anticoagulation (RCA) on continuous blood purification (CBP) during the treatment of multiple organ dysfunction syndrome (MODS). Thirty-five patients with MODS were divided into two groups: the local citrate anticoagulation (RCA) group, and the heparin-free blood purification (hfBP) group. The MODS severity was assessed according to Marshall's MODS score criteria. Blood coagulation indicators, blood pressure, filter lifespan, filter replacement frequency, anticoagulation indicators, and main metabolic and electrolyte indicators were analyzed and compared between RCA and hfBP groups...
November 17, 2017: Brazilian Journal of Medical and Biological Research, Revista Brasileira de Pesquisas Médicas e Biológicas
https://www.readbyqxmd.com/read/29171099/regional-citrate-anticoagulation-for-intermittent-hemodialysis-in-dogs
#5
T Francey, A Schweighauser
BACKGROUND: The traditional systemic heparinization used for anticoagulation in extracorporeal therapies may cause fatal complications in animals at risk of bleeding. HYPOTHESIS/OBJECTIVES: To develop and validate a protocol of regional citrate anticoagulation (RCA) for intermittent hemodialysis in dogs. ANIMALS: A total of 172 dogs treated with hemodialysis for acute kidney injury. METHODS: In vitro titration was performed, adding trisodium citrate and calcium chloride to heparinized canine blood...
November 24, 2017: Journal of Veterinary Internal Medicine
https://www.readbyqxmd.com/read/29151020/complications-of-regional-citrate-anticoagulation-accumulation-or-overload
#6
Antoine G Schneider, Didier Journois, Thomas Rimmelé
Regional citrate anticoagulation (RCA) is now recommended over systemic heparin for continuous renal replacement therapy in patients without contraindications. Its use is likely to increase throughout the world. However, in the absence of citrate blood level monitoring, the diagnosis of citrate accumulation, the most feared complication of RCA, remains relatively complex. It is therefore commonly mistaken with other conditions. This review aims at providing clarifications on RCA-associated acid-base disturbances and their management at the bedside...
November 19, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29123570/cyclophosphamide-and-regional-citrate-anticoagulation-a-sour-combination
#7
Tim Hendra, Jonathan Simon, Alastair Lowe
We present a case of a woman in her 70 s, on cyclophosphamide for multiple myeloma, who was admitted to critical care with grade III acute kidney injury. Renal replacement therapy with regional citrate anticoagulation was commenced. Shortly thereafter her systemic-ionised calcium levels fell and remained stubbornly low until post-filter calcium return was doubled. Her total-to-ionised calcium ratio gradually increased and so, to avoid further accumulation of citrate, anticoagulation was changed to heparin...
November 2017: Journal of the Intensive Care Society
https://www.readbyqxmd.com/read/29118829/evaluating-the-safety-and-efficacy-of-regional-citrate-compared-to-systemic-heparin-as-anticoagulation-for-continuous-renal-replacement-therapy-in-critically-ill-patients-a-service-evaluation-following-a-change-in-practice
#8
Roberta Borg, Debra Ugboma, Dawn-Marie Walker, Richard Partridge
Following the implementation of citrate anticoagulation for continuous renal replacement therapy, we evaluate its first year of use and compare it to the previously used heparin, to assess whether our patients benefit from the recently reported advantages of citrate. We retrospectively analysed 2 years of data to compare the safety and efficacy of citrate versus heparin. The results have shown that 43 patients received continuous renal replacement therapy with heparin, 37 patients with citrate. We found no significant difference in metabolic control of pH, urea and creatinine after 72 h...
August 2017: Journal of the Intensive Care Society
https://www.readbyqxmd.com/read/29027706/regional-citrate-anticoagulation-with-calcium-replacement-in-pediatric-apheresis
#9
Katie Sigler, Ji Lee, Poyyapakkam Srivaths
PURPOSE: The objective of this retrospective analysis was to present our single-center experience with intravenous (IV) calcium replacement and regional citrate anticoagulation in pediatric apheresis therapy with the aim of developing a standard operating procedure to minimize symptomatic hypocalcemia. METHODS: We analyzed apheresis procedures in patients <18 years of age over a 2-year time period (Jan 2012 to Dec 2014). Procedures in tandem with other extracorporeal therapies, including continuous renal replacement therapy, extracorporeal liver support, and extracorporeal membrane oxygenation, were excluded...
October 13, 2017: Journal of Clinical Apheresis
https://www.readbyqxmd.com/read/28979536/citrate-versus-non-citrate-anticoagulation-in-continuous-renal-replacement-therapy-results-following-a-change-in-local-critical-care-protocol
#10
Samina R Chowdhury, Tom Lawton, Aaqid Akram, Robert Collin, James Beck
Continuous renal replacement therapy necessitates the use of anticoagulation. The anticoagulant of choice has traditionally been heparin. Emerging evidence has highlighted the deleterious effects of systemic heparin anticoagulation in the critically ill. Regional citrate anticoagulation has been used as an alternative in the setting of continuous renal replacement therapy. Our retrospective before-and-after cohort study aimed to ascertain if regional citrate anticoagulation is associated with any benefit in terms of circuit longevity, rates of complications, blood transfusion requirements and mortality, when introduced to a large general intensive care unit with a case mix of acute medical patients and acute and elective surgical patients...
February 2017: Journal of the Intensive Care Society
https://www.readbyqxmd.com/read/28969597/the-effect-of-regional-citrate-anti-coagulation-on-the-coagulation-system-in-critically-ill-patients-receiving-continuous-renal-replacement-therapy-for-acute-kidney-injury-an-observational-cohort-study
#11
Richard Fisher, Katie Lei, Mike J Mitchell, Gary W Moore, Helen Dickie, Linda Tovey, Siobhan Crichton, Marlies Ostermann
BACKGROUND: Regional anticoagulation with citrate is the recommended first line treatment for patients receiving continuous renal replacement therapy (CRRT). There is wide variability in filter patency which may be due to differences in patient characteristics and local practice. It is also possible that citrate has effects on primary and secondary haemostasis, fibrinolysis and platelet function that are still unknown. The primary aim of the study is to describe the effect of citrate on coagulation and fibrinolysis pathways in both the patient and the haemodialysis circuit...
October 2, 2017: BMC Nephrology
https://www.readbyqxmd.com/read/28871391/hemofiltration-induces-generation-of-leukocyte-derived-cd31-cd41-microvesicles-in-sepsis
#12
Georg Franz Lehner, Ulrich Harler, Clemens Feistritzer, Viktoria Maria Haller, Julia Hasslacher, Romuald Bellmann, Michael Joannidis
BACKGROUND: Microvesicles (MV) are extracellular vesicles known to be associated with cellular activation and inflammation. Hemofiltration is an effective blood purification technique for patients with renal failure and possibly also eliminates inflammatory mediators in the setting of sepsis. On the other hand, proinflammatory stimuli are induced by blood contacting the artificial membrane during extracorporeal blood purification. In chronic dialysis patients a systemic increase in MV has been described...
September 4, 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/28862718/clinical-impact-of-regional-citrate-anticoagulation-in-continuous-renal-replacement-therapy-in-critically-ill-patients
#13
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
https://www.readbyqxmd.com/read/28857854/heparin-free-prolonged-intermittent-hemodialysis-using-calcium-free-citrate-dialysate-in-critically-ill-patients
#14
Stanislas Faguer, Morgane Saint-Cricq, Marie-Béatrice Nogier, Isabelle Labadens, Laurence Lavayssiere, Nassim Kamar, Olivier Cointault
OBJECTIVES: Critically ill patients who have a high risk of bleeding but require prolonged intermittent dialysis need a heparin-free easy-to-use alternative type of anticoagulation within the dialysis circuit. We assessed the safety and efficiency of heparin-free regional citrate anticoagulation of the dialysis circuit using a calcium-free citrate-containing dialysate, with calcium reinjected according to ionic dialysance. DESIGN: Prospective cohort study. SETTING: Critical care units...
November 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28792509/regional-citrate-anticoagulation-for-continuous-renal-replacement-therapy-in-pediatric-patients-with-liver-failure
#15
Keila Rodriguez, Poyyapakkam R Srivaths, Leyat Tal, Mary N Watson, Alyssa A Riley, Ryan W Himes, Moreshwar S Desai, Michael C Braun, Ayse Akcan Arikan
Pediatric liver failure patients frequently develop multiple organ failure and require continuous renal replacement therapy (CRRT) as part of supportive therapy in the pediatric intensive care unit. While many centers employ no anticoagulation for fear of bleeding complications, balanced coagulation disturbance predisposes these patients to clotting as well as bleeding, making maintenance of longer circuit life to deliver adequate dialysis clearance challenging. Regional citrate anticoagulation (RCA) is an attractive option as it avoids systemic anticoagulation, but since citrate metabolism is impaired in liver failure, concerns about toxicity has limited its use...
2017: PloS One
https://www.readbyqxmd.com/read/28682569/-nephrologist-and-icu-the-need-of-new-expertise
#16
Filippo Mariano, Marco Pozzato
Episodes of dialytic Acute Kidney Injury (AKI stage III KDIGO) can lead to chronic kidney disease (CKD), even after a long time. Prelimary data indicate that the relationship between AKI and CKD is affected by dialysis technical modalities and factors in part modifiable, such as an early dialysis timing, dose adeguacy, continuous treatment, use of biocompatible membranes and regional citrate anticoagulation. However, in most ICUs involvement of nephrologist consultant is marginal. Of more, nephrological follow-up after discharge, which allows to slow down the progression rate of CKD even just by a correct pharmacological and dietetic approach (sartans, ACEis), is an uncommon practice...
April 2017: Giornale Italiano di Nefrologia: Organo Ufficiale Della Società Italiana di Nefrologia
https://www.readbyqxmd.com/read/28664840/anticoagulation-assessment-methods-in-plasma-exchange-with-regional-citrate-anticoagulation-evaluation-of-post-filter-and-filtered-plasma-ionized-calcium
#17
Manja Antonič, Jakob Gubenšek, Jadranka Buturović-Ponikvar, Rafael Ponikvar
AIM: To assess the possibility of using filtered plasma instead of postfilter ionized calcium (iCa) for the assessment of anticoagulation in plasma exchange (PE) with citrate anticoagulation. METHODS: 140 PE treatments were performed using either 4% or 15% citrate at a comparable dose. Paired samples of postfilter blood and filtered plasma were taken for iCa measurements with a point-of-care analyzer. Anticoagulation was also assessed with a bedside clotting time and visual assessment of the circuit after procedures...
2017: Clinical Nephrology
https://www.readbyqxmd.com/read/28618127/regional-citrate-anticoagulation-in-membrane-based-plasma-exchange-safety-efficacy-and-effect-on-calcium-balance
#18
Daniel Christiadi, Chari Mercado, Richard Singer
AIM: To assess the efficacy, safety and calcium balance of a membrane based regional citrate anticoagulation plasma exchange protocol METHODS: This was an observational, prospective, single center study of membrane separation plasma exchange using regional citrate anticoagulation. It was performed using a fixed dose pre-filter citrate infusion that was based on the plasma flow rate. Patients received a post filter calcium infusion which was modified during treatment based on systemic ionized calcium monitoring...
June 15, 2017: Nephrology
https://www.readbyqxmd.com/read/28578542/citrate-versus-heparin-anticoagulation-in-continuous-renal-replacement-therapy-in-small-children
#19
Paulien A M A Raymakers-Janssen, Marc Lilien, Ingrid A van Kessel, Esther S Veldhoen, Roelie M Wösten-van Asperen, Josephus P J van Gestel
BACKGROUND: Citrate is preferred over heparin as an anticoagulant in adult continuous renal replacement therapy (CRRT). However, its potential adverse effects and data on use in CRRT in infants and toddlers is limited. We conducted a prospective study on using citrate in CRRT in critically ill small children. METHODS: Children who underwent CRRT with the smallest filter in our PICU between November 2011 and November 2016 were included. Both heparin and citrate were applied according to a strict protocol...
June 4, 2017: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
https://www.readbyqxmd.com/read/28578343/filter-size-not-the-anticoagulation-method-is-the-decisive-factor-in-continuous-renal-replacement-therapy-circuit-survival
#20
Monika Miklaszewska, Przemysław Korohoda, Katarzyna Zachwieja, Krzysztof Kobylarz, Constantinos J Stefanidis, Alina Sobczak, Dorota Drożdż
BACKGROUND/AIM: As continuous renal replacement therapy (CRRT) has emerged as a standard therapy in pediatric intensive care units (PICU), many related issues that may have an impact on circuit survival have gained in importance. Objective of the study was an evaluation of factors associated with circuit survival, including anticoagulation (ACG). METHODS: Retrospective study that included 40 patients, who in total received 7636 hours of CRRT during 150 sessions (84 filters, 4260 hours with heparin anticoagulation (Hep-ACG); 66 filters, 3376 hours with regional citrate anticoagulation (RCA))...
2017: Kidney & Blood Pressure Research
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