Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 21 , ISSUE 1 ( 2017 ) > List of Articles

RESEARCH ARTICLE

Experiences with continuous venovenous hemofiltration using 18mmol/l predilution citrate anticoagulation and a phosphate containing replacement solution

Yuen Jeffrey, Shum Hoi-Ping, Anne Kit Hung, Lam Chung-Ling, Yan Wing-Wa, Lai King-Yiu

Keywords : Acute renal failure, anticoagulation, citrate, continuous renal replacement therapy

Citation Information : Jeffrey Y, Hoi-Ping S, Kit Hung A, Chung-Ling L, Wing-Wa Y, King-Yiu L. Experiences with continuous venovenous hemofiltration using 18mmol/l predilution citrate anticoagulation and a phosphate containing replacement solution. Indian J Crit Care Med 2017; 21 (1):11-16.

DOI: 10.4103/0972-5229.198311

License: CC BY-ND 3.0

Published Online: 00-01-2017

Copyright Statement:  Copyright © 2017; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Context: Regional citrate anticoagulation for continuous renal replacement therapy is associated with a longer filter-life, less bleeding events and improved mortality. Problems associated with using Prismocitrate 10/2 solution in continuous renal replacement therapy, include hypomagnesemia, hypophosphatemia and the need for additional bicarbonate infusion. Aims: This study uses the new Prismocitrate 18/0 solution for improved buffer balance and Phoxilium solution for a more favourable electrolyte profile. Settings and Design: A retrospective analysis of patients who underwent continuous venovenous hemofiltration (CVVH) using Prismocitrate 18/0 and Phoxilium in our 21-bed ICU was conducted from March to July 2014. Methods and Material: Continuous venovenous hemofiltration (CVVH) was performed at fixed rate by using Prismocitrate 18/0 predilution at 1250 ml/hour, a blood flow rate of 110 ml/min and post-replacement with Phoxilium at 1250 ml/hr. CVVH was run for 72 h or until filter clotting, transportation, or achievement of the clinical target. Statistical Analysis Used: The results were displayed as the median with the interquartile range (IQR). The trend in pH, electrolytes, and base excess are shown using a standard box plot. All analyses were performed by the Statistical Package for Social Science for Windows, version 17 (SPSS, Chicago, IL, USA). Results: Forty-five CVVH episodes were analysed. The median circuit lifetime was 44 h (interquartile range, IQR 29-55). Metabolic alkalosis, hypophosphatemia and hypomagnesemia occurred in 8.3%, 3.5% and 40.2% of the blood samples, respectively. No patient developed hypokalemia or citrate toxicity. Conclusions: This new CVVH regime is safe and easy to administer for critically ill patients.


PDF Share
  1. Monti G, Herrera M, Kindgen-Milles D, Marinho A, Cruz D, Mariano F, et al. The DOse REsponse Multicentre International Collaborative Initiative (DO-RE-MI). Contrib Nephrol 2007;156:434-43.
  2. Bihorac A, Ross EA. Continuous venovenous hemofiltration with citrate-based replacement fluid: Efficacy, safety, and impact on nutrition. Am J Kidney Dis 2005;46:908-18.
  3. Oudemans-van Straaten HM, Bosman RJ, Koopmans M, van der Voort PH, Wester JP, van der Spoel JI, et al. Citrate anticoagulation for continuous venovenous hemofiltration. Crit Care Med 2009;37:545-52.
  4. Leung AK, Shum HP, Chan KC, Chan SC, Lai KY, Yan WW. A retrospective review of the use of regional citrate anticoagulation in continuous venovenous hemofiltration for critically ill patients. Crit Care Res Pract 2013;2013:349512.
  5. Shum HP, Chan KC, Yan WW. Regional citrate anticoagulation in predilution continuous venovenous hemofiltration using Prismocitrate 10/2 solution. Ther Apher Dial 2012;16:81-6.
  6. Broman M, Carlsson O, Friberg H, Wieslander A, Godaly G. Phosphate-containing dialysis solution prevents hypophosphatemia during continuous renal replacement therapy. Acta Anaesthesiol Scand 2011;55:39-45.
  7. Chua HR, Schneider AG, Baldwin I, Collins A, Ho L, Bellomo R. Phoxilium vs. Hemosol-B0 for continuous renal replacement therapy in acute kidney injury. J Crit Care 2013;28:884.e7-14.
  8. Morabito S, Pistolesi V, Tritapepe L, Vitaliano E, Zeppilli L, Polistena F, et al. Continuous venovenous hemodiafiltration with a low citrate dose regional anticoagulation protocol and a phosphate-containing solution: Effects on acid-base status and phosphate supplementation needs. BMC Nephrol 2013;14:232.
  9. Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract 2012;120:c179-84.
  10. Meier-Kriesche HU, Gitomer J, Finkel K, DuBose T. Increased total to ionized calcium ratio during continuous venovenous hemodialysis with regional citrate anticoagulation. Crit Care Med 2001;29:748-52.
  11. Wu MY, Hsu YH, Bai CH, Lin YF, Wu CH, Tam KW. Regional citrate versus heparin anticoagulation for continuous renal replacement therapy: A meta-analysis of randomized controlled trials. Am J Kidney Dis 2012;59:810-8.
  12. Zhang Z, Hongying N. Efficacy and safety of regional citrate anticoagulation in critically ill patients undergoing continuous renal replacement therapy. Intensive Care Med 2012;38:20-8.
  13. Tolwani AJ, Prendergast MB, Speer RR, Stofan BS, Wille KM. A practical citrate anticoagulation continuous venovenous hemodiafiltration protocol for metabolic control and high solute clearance. Clin J Am Soc Nephrol 2006;1:79-87.
  14. Brain MJ, Roodenburg OS, Adams N, McCracken P, Hockings L, Musgrave S, et al. Randomised trial of software algorithm driven regional citrate anticoagulation versus heparin in continuous renal replacement therapy: The filter life in renal replacement therapy pilot trial. Crit Care Resusc 2014;16:131-7.
  15. RENAL Replacement Therapy Study Investigators, Bellomo R, Cass A, Cole L, Finfer S, Gallagher M, et al. Intensity of continuous renal-replacement therapy in critically ill patients. N Engl J Med 2009;361:1627-38.
  16. VA/NIH Acute Renal Failure Trial Network, Palevsky PM, Zhang JH, O′Connor TZ, Chertow GM, Crowley ST, et al. Intensity of renal support in critically ill patients with acute kidney injury. N Engl J Med 2008;359:7-20.
  17. Jun M, Heerspink HJ, Ninomiya T, Gallagher M, Bellomo R, Myburgh J, et al. Intensities of renal replacement therapy in acute kidney injury: A systematic review and meta-analysis. Clin J Am Soc Nephrol 2010;5:956-63.
  18. Brandl M, Strobl K, Hartmann J, Kellner K, Posnicek T, Falkenhagen D. A target-orientated algorithm for regional citrate-calcium anticoagulation in extracorporeal therapies. Blood Purif 2012;33:7-20.
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.