Regional Citrate Anticoagulation for Continuous Kidney Replacement Therapy With Calcium-Containing Solutions: A Cohort Study

Overview

Journal Am J Kidney Dis

Specialty Nephrology

Date 2021 Apr 2

PMID 33798636

Citations 12

Authors

Harin Rhee

Brendan Berenger

Ravindra L Mehta

Etienne Macedo

Affiliations

Soon will be listed here.

Abstract

Objective: Regional citrate anticoagulation (RCA) is the preferred anticoagulation method for continuous kidney replacement therapy (CKRT) recommended by KDIGO. Limited availability of calcium-free solutions often imposes challenges to the implementation of RCA for CKRT (RCA-CKRT). The principal purpose of this study was to characterize the outcomes of RCA-CKRT using calcium-containing solutions.

Study Design: Retrospective cohort study.

Setting & Participants: We evaluated the safety and efficacy of RCA-CKRT with calcium-containing dialysate and replacement fluid used for 128 patients. A total of 571 filters and 1,227 days of CKRT were analyzed.

Exposures: Liver disease, sepsis in the absence of liver disease, and sepsis with liver disease.

Outcomes: Filter life and metabolic complications per 100 CKRT days.

Analytical Approach: Linear mixed-effects model and generalized linear mixed-effects models.

Results: The majority of patients were male (91; 71.1%), 32 (25%) had liver disease, and 29 (22.7%) had sepsis without liver disease. Median filter life was 50.0 (interquartile range, 22.0-118.0) hours, with a maximum of 322 hours, and was significantly lower (33.5 [interquartile range, 17.5-60.5] h) in patients with liver disease. Calcium-containing replacement solutions were used in 41.6% of all CKRT hours and reduced intravenous calcium requirements by 31.7%. Hypocalcemia (ionized calcium<0.85mmol/L) and hypercalcemia (total calcium>10.6mg/dL) were observed in 6.0 and 6.7 per 100 CKRT days, respectively. Citrate accumulation was observed in 13.3% of all patients and was associated with metabolic acidosis in 3.9%, which was not significantly different in patients with liver disease (9.3%; P = 0.2).

Limitations: Lack of control groups that used calcium-free dialysate and replacement solutions with RCA-CKRT. Possible overestimation of filter life from incomplete data on cause of filter failure.

Conclusions: Our study suggests that RCA-CKRT with calcium-containing solutions is feasible and safe in critically ill patients, including those with sepsis and liver disease.

Citing Articles

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The role of nafamostat mesylate anticoagulation in continuous kidney replacement therapy for critically ill patients with bleeding tendencies: a retrospective study on patient outcomes and safety.

Kim T, Kim D, Jo E, Lee Y, Kim D, Kim H Kidney Res Clin Pract. 2024; 43(4):469-479.

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Nephrology consultation improves the clinical outcomes of patients with acute kidney injury.

Rhee H, Park M, Kim I Kidney Res Clin Pract. 2023; 44(1):102-110.

PMID: 37798849 PMC: 11838846. DOI: 10.23876/j.krcp.23.039.

Safety of Citrate Anticoagulation in CKRT: Monocentric Experience of a Dynamic Protocol of Calcium Monitoring.

Nalesso F, Bettin E, Bogo M, Cacciapuoti M, Cattarin L, Scaparrotta G J Clin Med. 2023; 12(16).

PMID: 37629242 PMC: 10455350. DOI: 10.3390/jcm12165201.

Rapid implementation of an emergency on-site CKRT dialysate production system during the COVID-19 pandemic.

Teixeira J, Saa L, Kaucher K, Villanueva R, Shieh M, Baca C BMC Nephrol. 2023; 24(1):245.

PMID: 37608357 PMC: 10463836. DOI: 10.1186/s12882-023-03260-9.

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