Please use this identifier to cite or link to this item: http://ahro.austin.org.au/austinjspui/handle/1/10009
Title: Commercial low-citrate anticoagulation haemofiltration in high risk patients with frequent filter clotting.
Authors: Naka, Toshio;Egi, Moritoki;Bellomo, Rinaldo;Cole, Louise;French, C;Botha, J;Wan, Li;Fealy, Nigel;Baldwin, Ian
Affiliation: Department of Intensive Care and Medicine (University of Melbourne), Austin Hospital, Austin Health, Victoria.
Issue Date: 1-Oct-2005
Citation: Anaesthesia and Intensive Care; 33(5): 601-8
Abstract: This study assessed the safety and efficacy of a commercial low-citrate concentration-based pre-filter replacement fluid during continuous veno-venous haemofiltration (CVVH) in patients with frequent filter clotting and high risk of bleeding. We used a commercial low-citrate fluid as pre-dilution replacement fluid during CVVH (citrate: 11 mmol/l (33 meq/l), sodium: 140 mmol/l, chloride: 108 mmol/l and potassium: 1 mmol/l). A calcium and magnesium infusion was delivered separately by central line for the maintenance of serum ionized calcium (Cai) and total magnesium (Mg). In this prospective observational study, 30 patients, 124 filters and 1,515 treatment-hours were observed. Median filter life of citrate CVVH was 9.5 hours. Filter life in the 48 hours prior to citrate CVVH was also observed. In the patients on prior non-anticoagulant CVVH (n=14) filter life increased significantly with citrate (9.5 hours vs 5 hours; P<0.0001). In patients on prior heparin CVVH (n = 15), filter life was similar with citrate (10 hours vs 8 hours; P = 0.68). However, in patients with prior early/frequent filter clotting despite heparin (n = 11) filter life increased significantly (10 hours vs 7 hours; P=0.038). Of 411 serum Cai measurements, none showed a Cai < 0.85 mmol/l and, of 84 observations, none showed a serum Mg<0. 6 mmol/l. One patient with sepsis and shock needed to cease citrate CVVH because of progressive ionized hypocalcaemia and increasing anion gap. No other adverse effects were observed. In selected patients, CVVH with a commercial low-citrate concentration solution as pre-filter replacement fluid and a simultaneous calcium and magnesium infusion protocol appears generally safe. Filter life was acceptable and superior to that achieved with previous treatment.
Internal ID Number: 16235478
URI: http://ahro.austin.org.au/austinjspui/handle/1/10009
URL: http://www.ncbi.nlm.nih.gov/pubmed/16235478
Type: Journal Article
Subjects: Acute Kidney Injury.therapy
Aged
Anticoagulants.therapeutic use
Calcium.blood
Citrates.therapeutic use
Female
Hemofiltration.methods
Hospital Mortality
Humans
Intensive Care Units
Magnesium.blood
Male
Prospective Studies
Risk Factors
Appears in Collections:Journal articles

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