Analysis of the extracorporeal anticoagulation effect of modified citrate infusion during continuous renal replacement therapy in critically ill patients

Abstract

Introduction To analyze the anticoagulation effect of different local infusion methods of citrate underwent continuous renal replacement therapy (CRRT) in critically ill patients. Methods The study adopted a single‐centre retrospective design. Critically ill patients were divided into conventional group and modified group based on the infusion methods of citrate. Results The modified group had a longer mean treatment time (67.67 ± 18.69 hours vs. 52.11 ± 24.26 hours, p = 0.007), a lower transmembrane pressure (147.77 ± 66.85 cm H2O vs. 200.63 ± 118.66 cm H2O, p = 0.038), fewer citrate bag replacements (1.43 ± 0.50 times vs. 10.60 ± 3.19 times, p < 0.001), and more steady ionized calcium at the venous end (0.35 ± 0.06 mmol/L vs. 0.40 ± 0.05 mmol/L, p = 0.006) compared to the conventional group patients, with statistically significant differences. The incidences of citrate accumulation and tubing coagulation were marginally lower in the modified group. Conclusion The modified local citrate infusion method can prolong treatment time, while reducing both the nursing workload and the occurrence of citrate accumulation.

Factors affecting continuous renal replacement therapy duration in critically ill patients: A retrospective study

“…The ionized calcium levels in the CRRT tubing before supplementation with 10% calcium gluconate (venous iCa) and peripheral arteries (arterial iCa), were monitored during treatment. The infusion rates of blood-preserving solution and 10% calcium gluconate were adjusted according to the arterial and venous iCa levels to maintain the venous iCa at 0.25-0.35 mmol/L and arterial iCa at 1.0-1.2 mmol/L to achieve a relatively good anticoagulation effect [3,12].…”

“…The principle of RCA is that citrate binds to calcium ions in the blood thereby decreasing ionized calcium levels in the blood during cardiopulmonary bypass. The blood is not suitable for coagulation, thereby prolonging the treatment time of CRRT [3,10]. Therefore, the smaller the fluctuation of venous iCa and the closer it is to the low target value, the better the RCA effect and the longer the CRRT duration [3].…”

“…The blood is not suitable for coagulation, thereby prolonging the treatment time of CRRT [3,10]. Therefore, the smaller the fluctuation of venous iCa and the closer it is to the low target value, the better the RCA effect and the longer the CRRT duration [3]. Acidaemia can lead to blood hypo-coagulation, and a lower pH level is associated with longer filter life [24].…”

“…Therefore, CRRT has little effect on the haemodynamics of critically ill patients and can efficiently remove harmful substances from the blood. CRRT is used for renal replacement, and has been widely used in the treatment of critically ill patients as an important treatment modality in the intensive care unit (ICU) [2,3]. Commonly used treatment modalities include continuous veno-venous haemofiltration (CVVH), continuous venovenous hemodialysis (CVVHD), and continuous venovenous hemodiafiltration (CVVHDF) [1].…”

“…Previous studies have shown that blood flow velocity [4], treatment [4] and hemodilution mode [5,6], and other factors, in addition to anticoagulant factors, are related to CRRT time. Different anti-coagulant infusion modes have an impact on CRRT time [3]. Patients who are critically ill may have complex changes in pathophysiological mechanisms, such as coagulation changes, thrombocytopenia [7], and organ dysfunction.…”