Regional citrate anticoagulation protocol suitable for intermittent hemodialysis and post-dilution hemodiafiltration

2021 ◽  
Author(s):  
Esther Goet ◽  
Benjamin Wentz ◽  
Rolf Dario Frank
Keyword(s):  
Regional Citrate Anticoagulation ◽  
Intermittent Hemodialysis ◽  
Citrate Anticoagulation

A simple and novel technique for regional citrate anticoagulation during intermittent hemodialysis may obviate the need for calcium monitoring

2017 ◽  
Vol 43 (12) ◽  
pp. 1927-1928 ◽  
Author(s):  
Thomas Robert ◽  
Come Bureau ◽  
Ludivine Lebourg ◽  
Eric Rondeau ◽  
Thierry Petitclerc ◽  
...  
Keyword(s):  
Regional Citrate Anticoagulation ◽  
Intermittent Hemodialysis ◽  
Citrate Anticoagulation ◽  
Novel Technique

scholarly journals Comparison between regional citrate anticoagulation and heparin for intermittent hemodialysis in ICU patients: a propensity score-matched cohort study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Christophe Leroy ◽  
Bruno Pereira ◽  
Edouard Soum ◽  
Claire Bachelier ◽  
Elisabeth Coupez ◽  
...  
Keyword(s):  
Propensity Score ◽  
Regional Citrate Anticoagulation ◽  
Intermittent Hemodialysis ◽  
Efficacy And Safety ◽  
Icu Patients ◽  
Citrate Anticoagulation ◽  
Increased Risk ◽  
Heparin Anticoagulation ◽  
Calcium Infusion

Abstract Background Regional citrate anticoagulation (RCA) is the gold standard of anticoagulation for continuous renal replacement therapy but is rarely used for intermittent hemodialysis (IHD) in ICU. Few studies assessed the safety and efficacy of RCA during IHD in ICU; however, no data are available comparing RCA to heparin anticoagulation, which are commonly used for IHD. The aim of this study was to assess the efficacy and safety of RCA compared to heparin anticoagulation during IHD. Methods This retrospective single-center cohort study included consecutive ICU patients treated with either heparin anticoagulation (unfractionated or low-molecular-weight heparin) or RCA for IHD from July to September in 2015 and 2017. RCA was performed with citrate infusion according to blood flow and calcium infusion by diffusive influx from dialysate. Using a propensity score analysis, as the primary endpoint we assessed whether RCA improved efficacy, quantified with Kt/V from the ionic dialysance, compared to heparin anticoagulation. The secondary endpoint was safety. Exploratory analyses were performed on the changes in efficacy and safety between the implementation period (2015) and at long term (2017). Results In total, 208 IHD sessions were performed in 56 patients and were compared (124 RCA and 84 heparin coagulation). There was no difference in Kt/V between RCA and heparin (0.95 ± 0.38 vs. 0.89 ± 0.32; p = 0.98). A higher number of circuit clotting (12.9% vs. 2.4%; p = 0.02) and premature interruption resulting from acute high transmembrane pressure (21% vs. 7%; p = 0.02) occurred in the RCA sessions compared to the heparin sessions. In the propensity score-matching analysis, RCA was associated with an increased risk of circuit clotting (absolute differences = 0.10, 95% CI [0.03–0.18]; p = 0.008). There was no difference in efficacy and safety between the two time periods (2015 and 2017). Conclusion RCA with calcium infusion by diffusive influx from dialysate for IHD was easy to implement with stable long-term efficacy and safety but did not improve efficacy and could be associated with an increased risk of circuit clotting compared to heparin anticoagulation in non-selected ICU patients. Randomized trials to determine the best anticoagulation for IHD in ICU patients should be conducted in a variety of settings.

scholarly journals P1089REGIONAL CITRATE ANTICOAGULATION VERSUS LOW MOLECULAR WEIGHT HEPARIN ANTICOAGULATION FOR CONTINUS VENOVENOUS HEMOFILTRATION IN PATIENTS WITH SEVERE HYPERCALCEMIA: A RETROSPECTIVE CASE-CONTROL STUDY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Shiren Sun ◽  
Ming Bai ◽  
Yan Yu ◽  
Wei Zhang ◽  
Yangping Li
Keyword(s):  
Molecular Weight ◽  
Serum Calcium ◽  
Low Molecular Weight Heparin ◽  
Reduction Rate ◽  
Regional Citrate Anticoagulation ◽  
Low Molecular Weight ◽  
Intermittent Hemodialysis ◽  
Citrate Anticoagulation ◽  
Severe Hypercalcemia ◽  
Citrate Accumulation

Abstract Background and Aims Severe hypercalcemia, poor conservative treatment effect, or combined with renal dysfunction, heart failure, intermittent hemodialysis treatment is recommended. But calcium-free hemodialysis could cause rebound of serum calcium, hypovolemia and hypotension. Continuous renal replacement therapy (CRRT) is the most commonly used treatment in critically ill patients with severe AKI. Some case reports showed that CRRT successed control calcium with stable hemodynamics, no rebound hypercalcemia, but there was only one case used continuous venovenous hemofiltration (CVVH). During CVVH treatment, clotting in the extracorporeal circuit shortens the filter and catheter lifespan, causes blood loss, and decreases solute clearance, consequently, reduces the effectiveness of CVVH and increases the treatment cost and medical stuff’s workload. So how to safely decrease calcium level and how to choose appropriate anticoagulants during CVVH in esvere hypercalcemia patients is a challenging work. We conducted a retrospective study to evaluate the efficacy and safety of regional citrate anticoagulation (RCA) versus low molecular weight heparin (LMWH) anticoagulation for CVVH in severe hypercalcemia patients. Method Between January 2014 and May 2019, severe hypercalcemia patients requiring CVVH were screened and divided into the RCA and LMWH-anticoagulation group according to the CVVH anticoagulation strategy they accepted. Serum calcium reduction rate (RRSeCa), filter lifespan, bleeding, totCa/ionCa ratio, citrate accumulation, and catheter occlusion were evaluated as outcomes. Results Of the 33 included patients, RCA and LMWH-anticoagulation were employed for CVVH in 14 and 43 filters, respectively. The serum calcium reduction rate (RRSeCa) was not significantly different between the LMWH-anticoagulation and RCA group (P = 0.320). Compared to LMWH-anticoagulation, RCA significantly prolonged the filter lifespan (> 72 hours vs. 24.0 hours [IQR, 15.0-26.0], P = 0.012). The incidence of filter failure was 55.8% (24/43) in the LMWH -anticoagulation group and 21.4% (3/14) in the RCA group (P = 0.033), respectively. The adjusted results demonstrated that RCA could significantly reduce the risk of filter failure (P = 0.028, 95% CI 0.076-0.859, HR = 0.255). No citrate accumulation was observed in RCA-CVVH patients. Conclusion In patients with severe hypercalcemia who underwent CVVH, both RCA CVVH and LMWH-anticoagulation CVVH could effectively decrease calcium levels. RCA CVVH had better filter lifespan and no obvious adverse events, compared with the LMWH-anticoagulation CVVH. Further prospective, randomized, control studies are warranted to obtain robust evidences.

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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