Citrate Anticoagulation During Continuous Renal Replacement Therapy in Pediatric Critical Care

Davis, Thomas K.; Neumayr, Tara; Geile, Kira; Doctor, Allan; Hmeil, Paul

doi:10.1097/pcc.0000000000000148

Cited by 29 publications

(29 citation statements)

References 46 publications

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“…Regional citrate anticoagulation (RCA) is an ideal option in critically ill children after recent surgery or with coagulopathy. However, metabolic complications may occur principally due to excess of citrate .…”

Section: Evolution Of Total and Ionized Calcium Concentration Over Timementioning

confidence: 99%

Regional Citrate Anticoagulation: Beware of Recirculation Phenomenon

Chenouard

Liet

2017

Ther Apher Dial

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Section: Evolution Of Total and Ionized Calcium Concentration Over Timementioning

confidence: 99%

Regional Citrate Anticoagulation: Beware of Recirculation Phenomenon

Chenouard

Liet

2017

Ther Apher Dial

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“…Citrate is rapidly metabolised in the citric acid cycle, particularly in the liver, muscles and renal cortex. 7 We calculated citrate exposition based on a Sieving coefficient of 0.22, and the actual citrate administration rate, ultrafiltrate production and blood flow in individual patients on an hourly basis.…”

Section: Introductionmentioning

confidence: 99%

Relevance of non-nutritional calories in mechanically ventilated critically ill patients

et al. 2016

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Background/Objectives:Overfeeding in critically ill patients is associated with many complications. Propofol, dextrose infusion and citrate dialysis provide non-nutritional calories (NNCs), potentially causing overfeeding. The relevance of NNCs for total caloric intake has not been systematically studied.Subjects/Methods:We retrospectively studied adult mechanically ventilated intensive care unit (ICU) patients receiving enteral nutrition with or without supplemental parenteral nutrition. Primary outcome was the proportion of NNCs (from dextrose, propofol and trisodium citrate) to the total energy intake during the first 7 days after ICU admission. In addition, NNC intake groups were compared.Results:In total, we identified 146 patients: 142 patients with NNC median value of 580 kcal (interquartile range 310–1043 kcal) over 7 days and 4 patients without NNC intake. The mean proportion of NNCs was larger during the first days after ICU admission (30.7–36.1%), because of the start-up phase of the nutrition. In the ‘propofol' group and the ‘dextrose' group this proportion levelled off at 6% on day 4. A more stable proportion of 18% was found during the first 7 days of ICU admission in the ‘citrate' group.Conclusions:The mean proportion of NNCs in patients who receive dextrose and/or propofol is low (6%); however, in individual patients it may comprise one-third of the total daily calories. Patients receiving trisodium citrate have higher mean non-nutritional intakes (18%). As NNC intake can be marked in individual patients, close monitoring is warranted when administering high-dose propofol or trisodium citrate anticoagulation to prevent overfeeding.

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“…In the current literature, there are also contrary results that state that the mean circuit survival is no different between HepACG and RCA [19, 23]. In a study by Brophy et al [19], the clotting rates were similar for Hep-ACG circuits (25%) and RCA circuits (27%) and the analysis showed that 69% of Hep-ACG and Cit-ACG circuits were functional at 60 hours.…”

Section: Discussionmentioning

confidence: 94%

Filter Size Not the Anticoagulation Method is the Decisive Factor in Continuous Renal Replacement Therapy Circuit Survival

Miklaszewska

Korohoda

Zachwieja

et al. 2017

Kidney Blood Press Res

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Background/Aim: As continuous renal replacement therapy (CRRT) has emerged as a standard therapy in pediatric intensive care units (PICU), many related issues that may have an impact on circuit survival have gained in importance. Objective of the study was an evaluation of factors associated with circuit survival, including anticoagulation (ACG). Methods: Retrospective study that included 40 patients, who in total received 7636 hours of CRRT during 150 sessions (84 filters, 4260 hours with heparin anticoagulation (Hep-ACG); 66 filters, 3376 hours with regional citrate anticoagulation (RCA)). Results: The Kaplan-Meier analysis of the total circuit survival time depending on the type of ACG did not demonstrate a significant difference between Hep-ACG and RCA. The percentage of clotted filters was significantly higher in case of smaller filters (HF20: 58.8%; ST60: 29.5%; ST100: 15.8%), and their lifetime was significantly lower regardless of ACG (the mean and median lifetime for HF20: 38.7/27.0 h; for ST60: 54.1/72.0 h., for ST100: 62.1/72.0 h, respectively). Conclusions: Irrespectively of filter size, filter clotting occurs within the first 24 hours after the initiation of CRRT. Most commonly, clotting affects small filters, and their lifetime is significantly shorter as compared to larger filters regardless of the type of the ACG.

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Citrate Anticoagulation During Continuous Renal Replacement Therapy in Pediatric Critical Care

Cited by 29 publications

References 46 publications

Regional Citrate Anticoagulation: Beware of Recirculation Phenomenon

Regional Citrate Anticoagulation: Beware of Recirculation Phenomenon

Relevance of non-nutritional calories in mechanically ventilated critically ill patients

Filter Size Not the Anticoagulation Method is the Decisive Factor in Continuous Renal Replacement Therapy Circuit Survival

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