Advanced

Simplified citrate anticoagulation for CRRT without calcium replacement.

Broman, Marcus; Klarin, Bengt LU ; Sandin, Karin; Carlsson, Ola LU ; Wieslander, Anders; Sternby, Jan and Godaly, Gabriela LU (2015) In ASAIO Journal 61(4). p.437-442
Abstract
Since 2012 citrate anticoagulation is the recommended anticoagulation strategy for CRRT. The main drawback using citrate compared with heparin as anticoagulant 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 while the ionized calcium was kept at levels low enough to avoid clotting. Being a completely new concept, only five patients with acute renal failure were included in a short, prospective, intensely... (More)
Since 2012 citrate anticoagulation is the recommended anticoagulation strategy for CRRT. The main drawback using citrate compared with heparin as anticoagulant 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 while the ionized calcium was kept at levels low enough to avoid clotting. Being a completely new concept, only five patients with acute renal failure were included in a short, prospective, intensely supervised non-randomized pilot study.Systemic electrolyte levels and acid-base parameters were stable and remained within physiological levels. Ionized calcium levels declined slightly initially, but stabilized at 1.1 mmol/l. Plasma citrate concentrations stabilized at around 0.6 mmol/l. All post-filter ionized calcium levels were <0.5 mmol/l, i.e. 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. (Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
ASAIO Journal
volume
61
issue
4
pages
437 - 442
publisher
Amercian Society of Artificial Internal Organs
external identifiers
  • pmid:25851312
  • wos:000358285100012
  • scopus:84937558162
ISSN
1538-943X
DOI
10.1097/MAT.0000000000000226
language
English
LU publication?
yes
id
c3d8dea5-b556-47fd-b7dd-aee2fb96ac76 (old id 5345190)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/25851312?dopt=Abstract
date added to LUP
2015-05-06 14:58:27
date last changed
2017-05-07 03:00:24
@article{c3d8dea5-b556-47fd-b7dd-aee2fb96ac76,
  abstract     = {Since 2012 citrate anticoagulation is the recommended anticoagulation strategy for CRRT. The main drawback using citrate compared with heparin as anticoagulant 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 while the ionized calcium was kept at levels low enough to avoid clotting. Being a completely new concept, only five patients with acute renal failure were included in a short, prospective, intensely supervised non-randomized pilot study.Systemic electrolyte levels and acid-base parameters were stable and remained within physiological levels. Ionized calcium levels declined slightly initially, but stabilized at 1.1 mmol/l. Plasma citrate concentrations stabilized at around 0.6 mmol/l. All post-filter ionized calcium levels were &lt;0.5 mmol/l, i.e. 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.},
  author       = {Broman, Marcus and Klarin, Bengt and Sandin, Karin and Carlsson, Ola and Wieslander, Anders and Sternby, Jan and Godaly, Gabriela},
  issn         = {1538-943X},
  language     = {eng},
  number       = {4},
  pages        = {437--442},
  publisher    = {Amercian Society of Artificial Internal Organs},
  series       = {ASAIO Journal},
  title        = {Simplified citrate anticoagulation for CRRT without calcium replacement.},
  url          = {http://dx.doi.org/10.1097/MAT.0000000000000226},
  volume       = {61},
  year         = {2015},
}