Financial support/funding: None.
Regional Citrate Anticoagulation in Predilution Continuous Venovenous Hemofiltration Using Prismocitrate 10/2 Solution
Article first published online: 3 OCT 2011
© 2011 The Authors. Therapeutic Apheresis and Dialysis © 2011 International Society for Apheresis
Therapeutic Apheresis and Dialysis
Volume 16, Issue 1, pages 81–86, February 2012
How to Cite
Shum, H.-P., Chan, K.-C. and Yan, W.-W. (2012), Regional Citrate Anticoagulation in Predilution Continuous Venovenous Hemofiltration Using Prismocitrate 10/2 Solution. Therapeutic Apheresis and Dialysis, 16: 81–86. doi: 10.1111/j.1744-9987.2011.01001.x
Trial registration: Australian New Zealand Clinical Trials Registry (ANZCTR), No. ACTRN12611000099921.
- Issue published online: 17 JAN 2012
- Article first published online: 3 OCT 2011
- Received April 2011; revised June 2011.
- Acute renal failure;
- Continuous renal replacement therapy
Regional citrate anticoagulation (RCA) for continuous renal replacement therapy (CRRT) is associated with a longer filter life and fewer bleeding events. Complexity of the regimen is the major hurdle preventing widespread application. This study describes a simple predilution continuous venovenous hemofiltration (CVVH) protocol utilizing a commercially prepared replacement solution containing citrate (Prismocitrate 10/2). Ten patients with acute renal failure were evaluated. The Prismaflex system was used for predilution CVVH, with Prismocitrate 10/2 running at 2500 mL/h as the main predilution replacement. An 8.4% sodium bicarbonate solution was infused at 50 mL/h in the first 2 h followed by 30 mL/h; 10% calcium gluconate was given to achieve an ionized calcium (iCa) level of 1–1.2 mmol/L. The circuit was run for 72 h unless there was filter clotting, transportation was required, or the patient did not require further CRRT. Total treatment duration was 504.5 h. The post-dilution equivalent ultrafiltration rate was 32.9 mL/kg/h (interquartile range [IQR] 31.6–38.2) and the median circuit life was 50.3 h (IQR 25.5–72.0). None of the circuit was changed due to circuit clotting. The median systemic iCa was 0.98 mmol/L (IQR 0.91–1.08). The total calcium-to-iCa ratio was 2.33 (IQR 2.21–2.45). None of the patients developed hypernatremia (Na ≥ 150 mmol/L) or citrate toxicity (total Ca-to-iCa ratio > 2.5 plus increasing metabolic acidosis), and metabolic alkalosis (pH ≥ 7.5) occurred in one patient. This simple RCA CVVH protocol using commercially-prepared solution could be a feasible, relatively safe, and effective alternative to the conventional regimen for patients with a body weight up to 80 kg.