Citrate anticoagulation in haemofiltration using on-line produced calcium containing replacement solutions

 

Abstract

Background

Continuous renal replacement therapy, compared with intermittent haemodialysis, offers a better haemodynamic stability. The need to maintain the extracorporeal circuit patency is important. The use of systemic heparin is associated with significant risk of bleeding. Regional anticoagulation can be achieved with citrate. Various methods or protocols had been reported and regional citrate anticoagulation can produce metabolic complications

 

Methods

We retrospectively evaluated 20 critically ill patients who had undergone bicarbonate based on-line haemofiltration with regional citrate anticoagulation at our institution from November 2005 to April 2006.  Blood flow was maintained at 120-150ml/min. Anticoagulant citrate Dextrose-Formula A was infused through the arterial branch of the dialysis catheter at 240ml/hr.  Ultrafiltration was maintained at 2L/hr or more. Calcium containing replacement fluid was on-line produced and infused in a post-filer manner. Calcium chloride was infused via a central venous catheter to maintain serum ionised calcium level of at least 1.0 mmol/l.

  

Results

Twenty critically ill patients (median APACHE II score 31.5, range 17-48) were treated with on-line haemofiltration with the use of regional citrate anticoagulation. Analysis of the results showed that this technique was effective and safe in critically ill patients. No major metabolic complication was noted. There was no severe bleeding episode during on-line haemofiltration.

  

Conclusion

On-line haemofiltration with regional citrate anticoagulation is safe, effective and easy to execute in ICU. The use of on-line produced bicarbonate substitution fluid provide unlimited source of fluid for replacement which make the haemofiltration process much less labour intensive. In addition, the composition of the replacement solution can be adjusted according to the clinical condition. The simplified logistics can help to minimise error in the handling of replacement solution.

 

Keywords

Anticoagulation; citrate; on-line haemofiltration; replacement fluid

 

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