Calcium supplementation in CVVH using regional citrate anticoagulation

2019 ◽  
Author(s):  
Yin Zheng ◽  
Zhongye Xu ◽  
Qichen Fan ◽  
Qiuyu Zhu ◽  
Shuai Ma ◽  
...  
Keyword(s):  
Calcium Supplementation ◽  
Regional Citrate Anticoagulation ◽  
Citrate Anticoagulation

scholarly journals Implementation of a Simplified Regional Citrate Anticoagulation Protocol for Post-Dilution Continuous Hemofiltration Using a Bicarbonate Buffered, Calcium Containing Replacement Solution

2016 ◽  
Vol 42 (4) ◽  
pp. 349-355 ◽  
Author(s):  
Christopher J. Kirwan ◽  
Ross Hutchison ◽  
Sherif Ghabina ◽  
Stephanie Schwarze ◽  
Abigail Beane ◽  
...  
Keyword(s):  
Metabolic Alkalosis ◽  
Calcium Supplementation ◽  
Regional Citrate Anticoagulation ◽  
Prospective Audit ◽  
Bleeding Events ◽  
Continuous Hemofiltration ◽  
Citrate Anticoagulation ◽  
Replacement Solution ◽  
Acid Citrate Dextrose ◽  
Citrate Dextrose

Background/Aims: Recent updates to the Nikkiso Aquarius continuous renal replacement therapy (CRRT) platform allowed us to develop a post-dilution protocol for regional citrate anticoagulation (RCA) using standard bicarbonate buffered, calcium containing replacement solution with acid citrate dextrose formula-A as a citrate source. Our objective was to demonstrate that the protocol was safe and effective. Methods: Prospective audit of consecutive patients receiving RCA for CRRT within intensive care unit, who were either contraindicated to heparin or had poor filter lifespan (<12 h for 2 consecutive filters) on heparin. Results: We present the first 29 patients who used 98 filters. After excluding ‘non-clot' filter loss, 50% had a duration of >27 h. Calcium supplementation was required for 30 (30%) filter circuits, in 17 of 29 (58%) patients. One patient discontinued the treatment due to metabolic alkalosis, but there were no adverse bleeding events. Conclusion: Post-dilution RCA system is effective and simple to use on the Aquarius platform and results in comparable filter life for patients relatively contraindicated to heparin.

scholarly journals Anticoagulant effects of different calcium supplementation pathways in calcium-free RCA-CVVH: a study protocol for a prospective randomized cross-over trial

2019 ◽  
Author(s):  
Biantong JIANG ◽  
Zhigang ZHANG ◽  
Xiu JIN ◽  
Haiye WANG ◽  
Yuchen WU ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
Calcium Ions ◽  
Calcium Supplementation ◽  
Incidence Rates ◽  
Regional Citrate Anticoagulation ◽  
Citrate Anticoagulation ◽  
Catheter Dysfunction ◽  
Calcium Effect ◽  
The Difference ◽  
Key Aspects

Abstract Background When regional citrate anticoagulation used in continuous renal replacement therapy, one of the key aspects to achieve safe and effective extracorporeal circulation is the management of calcium ions. For calcium-free RCA-CVVH, the anticoagulant effects of different calcium supplementation pathways have not yet been explored. In this trial, we would test our hypothesis that compared with the SCV, when calcium was infused through the VL-FV, the arterial iCa2+ was lower. Methods This is a prospective randomized cross-over trial involving 24 patients undergoing RCA-CVVH. The patients were randomly divided into two groups: VL-FV—SCV group and SCV—VL-FV group. The difference of iCa2+ between arterial iCa2+ and post-filtration iCa2+ was compared. Secondary indicators included the incidence rates of catheter dysfunction and hypocalcemia. Discussion This is the first trial on the anticoagulant effects of calcium-free RCA-CVVH through different calcium supplement routes. We will confirm that the arterial iCa2 + level is slightly lower when calcium is infused in the VL-FV than in the SCV, and the incidence rates of catheter dysfunction and hypocalcemia will help us to determine which site is safer. Trial Registration CHiCTR registry: ChiCTR1800020046. Registered on 12 December 2018. (http://www.chictr.org.cn/listbycreater.aspx). Keywords: Continuous venous-venous hemofiltration, regional citrate anticoagulation, calcium, effect, safety, cross-over trial

Optimized Calcium Supplementation Approach for Regional Citrate Anticoagulation

Nephron ◽  
2018 ◽  
Vol 141 (2) ◽  
pp. 119-127 ◽  
Author(s):  
Wenyan Yu ◽  
Feng Zhuang ◽  
Shuai Ma ◽  
Qichen Fan ◽  
Mingli Zhu ◽  
...  
Keyword(s):  
Calcium Supplementation ◽  
Regional Citrate Anticoagulation ◽  
Citrate Anticoagulation

A target-oriented algorithm for maintaining serum calcium stability automatically in regional citrate anticoagulation

2020 ◽  
pp. 039139882098262
Author(s):  
Ruan-Mei Sheng ◽  
Wen-Biao Zhao ◽  
Li-Hong Huang ◽  
Jian-Qin Chen ◽  
Zhen-Juan Dai ◽  
...  
Keyword(s):  
Serum Calcium ◽  
Calcium Supplementation ◽  
Calcium Supplement ◽  
Regional Citrate Anticoagulation ◽  
Trial And Error ◽  
Citrate Anticoagulation ◽  
Replacement Solution ◽  
Free Replacement ◽  
Post Filter

Background: Regional citrate anticoagulation (RCA) for renal replacement therapy is widely practiced in critically ill patients. However, concern exists regarding its labor-intensiveness for monitoring and the associated hypocalcemia. In this study, we provided an algorithm for prescribing RCA and evaluated its safety in patients. Methods: During 18 hemofiltration treatments with calcium-free replacement solution, participants were randomized to receive algorithm-based or trial-and-error RCA protocol. The effluent volume, post-filter and in vivo ionized calcium (iCa), and calcium in the sera and effluents were periodically measured at an interval of 1 to 2 h. Results: For patients received algorithm-based RCA protocol, no one had a serum iCa less than 0.9 mmol/L, and none needed calcium supplement adjustment to maintain serum calcium stability. For patients accepted trial-and-error protocol, all patients had a serum iCa below 0.9 mmol/L, their serum iCa and calcium levels fluctuated dramatically, and all patients need additional calcium supplement adjustment during RCA. None of the participants showed a post-filter iCa > 0.4 mmol/L. Conclusion: We provided a safe algorithm for calculating calcium supplementation doses that could maintain serum calcium stability without additional adjustment during RCA.

Optimized calcium supplementation approach in post-dilution CVVHDF using regional citrate anticoagulation

2020 ◽  
pp. 039139882095181
Author(s):  
Xiao Bi ◽  
Qi Zhang ◽  
Feng Zhuang ◽  
Wei Lu ◽  
Feng Ding
Keyword(s):  
Calcium Concentration ◽  
Calcium Supplementation ◽  
Linear Regression Analysis ◽  
Regional Citrate Anticoagulation ◽  
Total Calcium ◽  
Flow Rates ◽  
Citrate Anticoagulation ◽  
Dialysate Flow ◽  
First Choice ◽  
Positive Correlations

Background: Regional citrate anticoagulation has been recommended as first choice for anticoagulation of continuous renal replacement therapy. Precise calcium supplementation is important for the safety of regional citrate anticoagulation. In this study we aimed to provide an optimized calcium supplementation approach for regional citrate anticoagulation in post-dilution continuous venous-venous hemodiafiltration. Methods: Twenty-seven patients receiving post-dilution continuous venous-venous hemodiafiltration anticoagulated by citrate were included in this study. The ionized calcium levels were monitored and maintained in the targeted range. After linear regression analysis of the clearance of non-protein bound calcium and calculating the ratio of the non-protein bound calcium concentration to total calcium concentration, we concluded the mathematical model for calcium supplementation. Results: Positive correlations were found between the clearance of non-protein bound calcium and both dialysate flow rates (r = 0.647, p < 0.001) and ultrafiltration plus substitution fluid flow rates (r = 0.525, p = 0.005). The ratio of the non-protein bound calcium concentration to total calcium concentration values at the pre-filter point after infusion of citrate were constant about 0.83. Based on the clearance and the calcium ratio, the amount of extracorporeal calcium removal can be estimated with a simplified equation. Conclusions: We provided an optimized calcium supplementation approach for post-dilution continuous venous-venous hemodiafiltration anticoagulated by citrate which may help to estimate the amount of extracorporeal circuit removal of calcium with regard to different dosages of regional citrate anticoagulation.

scholarly journals Discrepant post filter ionized calcium concentrations by common blood gas analyzers in CRRT using regional citrate anticoagulation

Critical Care ◽  
2015 ◽  
Vol 19 (1) ◽  
Author(s):  
Patrik Schwarzer ◽  
Sven-Olaf Kuhn ◽  
Sylvia Stracke ◽  
Matthias Gründling ◽  
Stephan Knigge ◽  
...  
Keyword(s):  
Ionized Calcium ◽  
Regional Citrate Anticoagulation ◽  
Blood Gas ◽  
Citrate Anticoagulation ◽  
Post Filter

scholarly journals Early warning of citric acid overdose and timely adjustment of regional citrate anticoagulation based on machine learning methods

2021 ◽  
Vol 21 (S2) ◽  
Author(s):  
Huan Chen ◽  
Yingying Ma ◽  
Na Hong ◽  
Hao Wang ◽  
Longxiang Su ◽  
...  
Keyword(s):  
Machine Learning ◽  
Citric Acid ◽  
Early Warning ◽  
Regional Citrate Anticoagulation ◽  
Support Vector ◽  
Learning Methods ◽  
Citrate Anticoagulation ◽  
Replacement Fluid ◽  
Machine Learning Methods ◽  
Neutral Networks

Abstract Background Regional citrate anticoagulation (RCA) is an important local anticoagulation method during bedside continuous renal replacement therapy. To improve patient safety and achieve computer assisted dose monitoring and control, we took intensive care units patients into cohort and aiming at developing a data-driven machine learning model to give early warning of citric acid overdose and provide adjustment suggestions on citrate pumping rate and 10% calcium gluconate input rate for RCA treatment. Methods Patient age, gender, pumped citric acid dose value, 5% NaHCO3 solvent, replacement fluid solvent, body temperature value, and replacement fluid PH value as clinical features, models attempted to classify patients who received regional citrate anticoagulation into correct outcome category. Four models, Adaboost, XGBoost, support vector machine (SVM) and shallow neural network, were compared on the performance of predicting outcomes. Prediction results were evaluated using accuracy, precision, recall and F1-score. Results For classifying patients at the early stages of citric acid treatment, the accuracy of neutral networks model is higher than Adaboost, XGBoost and SVM, the F1-score of shallow neutral networks (90.77%) is overall outperformed than other models (88.40%, 82.17% and 88.96% for Adaboost, XGBoost and SVM). Extended experiment and validation were further conducted using the MIMIC-III database, the F1-scores for shallow neutral networks, Adaboost, XGBoost and SVM are 80.00%, 80.46%, 80.37% and 78.90%, the AUCs are 0.8638, 0.8086, 0.8466 and 0.7919 respectively. Conclusion The results of this study demonstrated the feasibility and performance of machine learning methods for monitoring and adjusting local regional citrate anticoagulation, and further provide decision-making recommendations to clinicians point-of-care.

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