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Title: A comparison of two citrate anticoagulation regimens for continuous veno-venous hemofiltration.
Austin Authors: Egi, Moritoki;Naka, Toshio;Bellomo, Rinaldo ;Cole, Louise;French, C;Trethewy, C;Wan, Li;Langenberg, Christoph;Fealy, Nigel G ;Baldwin, Ian C 
Affiliation: Department of Intensive Care and Department of Medicine, Austin Hospital and Melbourne University, Melbourne - Australia
Issue Date: 1-Dec-2005
Publication information: The International Journal of Artificial Organs; 28(12): 1211-8
Abstract: To assess the safety and efficacy of two different commercial citrate containing pre-filter replacement fluids during continuous veno-venous hemofiltration (CVVH) in patients with frequent filter clotting.Four intensive care units.Sixty-three critically ill patients with acute renal failure (ARF).Prospective observational study.We used a commercial citrate fluid (citrate: 11 mmol/L -fluid A) as predilution replacement for CVVH. We then changed to a new commercial citrate fluid (citrate: 14 mmol/L-fluid B) as replacement fluid and performed statistical comparisons. Replacement fluid rate was fixed at 2,000 ml/hour.Filter life was 12.2 hour with fluid A compared with 17.1 hour with fluid B on average (p=0.0001). Mean post filter ionized calcium concentration was 0.52 mmol/L with fluid A compared with 0.40 mmol/L with fluid B (p<0.0001). Citrate intolerance led to cessation of treatment in one patient with fluid A and one patient with fluid B. Overall ionized calcium levels were higher (A: 1.18 vs B: 1.13 mmol/L; p<0.0001) and bicarbonate was lower (A: 22.4 vs B: 24.5 mmol/L; p<0.0001) during treatment with fluid A. Alkalemia was seen in 10 patients treated with fluid A and 16 patients treated with fluid B (NS).We have developed a simple approach to regional citrate anticoagulation for CVVH using a commercial citrate-containing fluid as replacement fluid. Increasing citrate concentration from 11 to 14 mmol/L increased filter life while maintaining relative safety and simplicity.
Gov't Doc #: 16404696
Journal: International Journal of Artificial Organs
Type: Journal Article
Subjects: Acute Kidney Injury.therapy
Anticoagulants.therapeutic use
Chi-Square Distribution
Citrates.therapeutic use
Critical Illness
Dialysis Solutions.therapeutic use
Middle Aged
Prospective Studies
Statistics, Nonparametric
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