PMID- 24811309
OWN - NLM
STAT- MEDLINE
DCOM- 20150330
LR  - 20171206
IS  - 1724-6040 (Electronic)
IS  - 0391-3988 (Linking)
VI  - 37
IP  - 6
DP  - 2014 Jun
TI  - A continuous veno-venous hemofiltration protocol with anticoagulant citrate 
      dextrose formula A and a calcium-containing replacement fluid.
PG  - 499-502
LID - 10.5301/ijao.5000323 [doi]
AB  - INTRODUCTION: Regional citrate anticoagulation (RCA) is used as an anticoagulant 
      for continuous renal replacement therapy (CRRT). A systemic calcium (Ca2+) 
      infusion is required to replace Ca2+ lost in the effluent. The shortage of 
      intravenous Ca2+ in the United States has limited RCA use. We describe a 
      continuous veno-venous hemofiltration (CVVH) protocol with RCA using 2.2% 
      anticoagulant citrate dextrose formula-A (ACD-A) and a commercial dialysate 
      containing Ca2+ 1.5 mmol/l (N x Stage) as post-filter replacement fluid (RF), 
      without need for Ca2+ infusion. METHODS: We prospectively evaluated five patients 
      on CRRT who had at least three episodes of filter clotting within 24 h. Patients 
      were switched to CVVH using ACD-A infused pre-blood pump and titrated to achieve 
      a post-filter ionized calcium (iCa2+) level <0.5 mmol/l. The Ca2+ -containing 
      dialysate was delivered post-filter as RF. RESULTS: Steady state mean serum 
      chemistries were: Na+: 140.8 +/- 2.3 meq/l, K+: 4.2 +/- 0.4 meq/l, HCO3-: 30.9 +/- 3.7 
      meq/l, pH: 7.42 +/- 0.07, CO2: 47.9 +/- 8.3 mmHg, total Ca2+: 8.08 +/- 1.09 mg/dL. 
      Post-filter iCa2+ ranged 0.27-0.36 mmol/l, and patient iCa2+ ranged 0.81-1.24 
      mmol/l. Mean post-filter RF rate: 3086 +/- 164 ml/h, mean ACD-A rate: 298 +/- 21 
      ml/h. Mean blood flow rate: 200 +/- 17 ml/min, mean filtration fraction: 39.6 +/- 
      7.2%. Mean effluent flow rate: 38.6 +/- 6.7 ml/kg/h (range 28.7-55.8). Mean filter 
      survival was 7 h without anticoagulation, compared to 42.6 h in the ACD-A group 
      (p<0.0001). CONCLUSIONS: In this pilot study, CVVH using ACD-A for RCA and a Ca2+ 
      -containing RF was safely and effectively used without a continuous Ca2+ 
      infusion. This protocol is a promising solution for maintaining effective CRRT 
      when intravenous calcium is in short supply.
FAU - Ong, Song C
AU  - Ong SC
AD  - 1 Department of Medicine, University of Alabama at Birmingham, Birmingham, AL - 
      USA.
FAU - Wille, Keith M
AU  - Wille KM
FAU - Speer, Rajesh
AU  - Speer R
FAU - Tolwani, Ashita J
AU  - Tolwani AJ
LA  - eng
PT  - Journal Article
DEP - 20140415
PL  - United States
TA  - Int J Artif Organs
JT  - The International journal of artificial organs
JID - 7802649
RN  - 0 (Anticoagulants)
RN  - 0 (Dialysis Solutions)
RN  - 2968PHW8QP (Citric Acid)
SB  - IM
MH  - Acute Kidney Injury/*therapy
MH  - Adult
MH  - Aged
MH  - Anticoagulants/*pharmacology/therapeutic use
MH  - Blood Coagulation/*drug effects
MH  - Citric Acid/*pharmacology/therapeutic use
MH  - Dialysis Solutions/pharmacology
MH  - Hemofiltration/*methods
MH  - Humans
MH  - Middle Aged
MH  - Pilot Projects
EDAT- 2014/05/09 06:00
MHDA- 2015/03/31 06:00
CRDT- 2014/05/10 06:00
PHST- 2014/03/11 00:00 [accepted]
PHST- 2014/05/10 06:00 [entrez]
PHST- 2014/05/09 06:00 [pubmed]
PHST- 2015/03/31 06:00 [medline]
AID - 6F3F45AC-1E19-4513-89B2-EA9C4440D35F [pii]
AID - 10.5301/ijao.5000323 [doi]
PST - ppublish
SO  - Int J Artif Organs. 2014 Jun;37(6):499-502. doi: 10.5301/ijao.5000323. Epub 2014 
      Apr 15.