Simplified Citrate Anticoagulation for CRRT Without Calcium Replacement
#MMPMID25851312
Broman M
; Klarin B
; Sandin K
; Carlsson O
; Wieslander A
; Sternby J
; Godaly G
ASAIO J
2015[Jul]; 61
(4
): 437-42
PMID25851312
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Since 2012, citrate anticoagulation is the recommended anticoagulation strategy
for continuous renal replacement therapy (CRRT). The main drawback using citrate
as anticoagulant compared with heparin is the need for calcium replacement and
the rigorous control of calcium levels. This study investigated the possibility
to achieve anticoagulation while eliminating the need for calcium replacement.
This was successfully achieved by including citrate and calcium in all CRRT
solutions. Thereby the total calcium concentration was kept constant throughout
the extracorporeal circuit, whereas the ionized calcium was kept at low levels
enough to avoid clotting. Being a completely new concept, only five patients with
acute renal failure were included in a short, prospective, intensely supervised
nonrandomized pilot study. Systemic electrolyte levels and acid-base parameters
were stable and remained within physiologic levels. Ionized calcium levels
declined slightly initially but stabilized at 1.1 mmol/L. Plasma citrate
concentrations stabilized at approximately 0.6 mmol/L. All postfilter ionized
calcium levels were <0.5 mmol/L, that is, an anticoagulation effect was reached.
All filter pressures were normal indicating no clotting problems, and no visible
clotting was observed. No calcium replacement was needed. This pilot study
suggests that it is possible to perform regional citrate anticoagulation without
the need for separate calcium infusion during CRRT.
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