Complications of Regional Citrate Anticoagulation for Continuous Renal Replacement Therapy: An Observational Study

Abstract

Introduction: Regional citrate anticoagulation (RCA) is the recommended anticoagulation modality for continuous renal replacement therapy (CRRT). RCA was associated with a low rate of complications in randomized controlled trials. However, little is known about the type and rate of complications in real life. We sought to describe complications associated with RCA in comparison with those associated with heparin anticoagulation. Methods: In our institution, RCA has been the default anticoagulation modality for CRRT in all patients without contraindications since 2013. We have retrospectively reviewed all consecutive patients who received CRRT between January and December 2016 in our institution. For each CRRT session, we have assessed circuit duration, administered dose, as well as therapy-associated complications. Those parameters were compared according to whether the circuit was run in continuous veno-venous hemodialysis (CVVHD) mode with RCA or continuous veno-venous hemofiltration (CVVH) mode with heparin anticoagulation. Results: We analyzed 691 CRRT sessions in 121 patients. Of those 400 (57.9%) were performed in CVVHD-RCA mode and 291 (42.1%) in CVVH-Heparin Mode. Compared with CVVH-Heparin mode, CVVHD-RCA mode was associated with a longer circuit lifespan (median duration 54.9 interquartile range [IQR 44.6] vs. 15.3 h [IQR 22.4], p < 0.0001). It was associated with a higher rate of metabolic acidosis 77 (20.2%) vs. 18 (7.2%), (p < 0.0001), alkalosis 186 (48.7%) vs. 43 (17.1%), (p = 0.0001), and hypocalcemia 96 (25.07%) vs. 26 events (10.79%), p < 0.0001. However, the majority of these alterations were of benign or moderate severity. Only one possible citrate intoxication was observed. Conclusions: CVVHD-RCA was associated with a much longer circuit life but an increased rate of minor metabolic complications, in particular acid-base derangements. Some of these complications might have been prevented by therapy adaptation. Medical and nursing staff education is of major importance in the implementation of an RCA protocol.

Tandem plasmapheresis and continuous kidney replacement treatment in pediatric patients

“…Hypocalcemia was reported 22-25.7% and 5.3% separately during CKRT and TPE respectively [14][15][16]. In our study, 147 instances of hypocalcemia < 1 mmol/L occurred over 203 treatments (72%) in 57 of 63 (90%) patients.…”

Research on the Effect of 5Why-Based Nursing Intervention in Blood Purification Nursing

“…However, maintenance hemodialysis patients with full public expenditure, who can get timely and satisfactory help from family members when encountering problems, have high family income, think that their personal health is good, and have no religious beliefs, have a higher satisfaction with the quality of life [ 17 ]. Bianchi et al [ 18 ] used a special scale for chronic kidney disease to investigate the quality of life of 102 patients with MDH and compared it with those in general health. The results confirmed that the nutritional status and beliefs of dialysis patients have a greater impact on their quality of life.…”

Low bicarbonate replacement fluid normalizes metabolic alkalosis during continuous veno-venous hemofiltration with regional citrate anticoagulation

“…Most existing RCA protocols recommend that either the adjustment of the blood flow or the replacement fluid/dialysate rate should be applied to correct acidbase disturbances during CRRT [21][22][23][24][25]. More specifically, a decrease of blood flow and/or an increase of replacement/dialysate fluid flow are considered as sufficient options to correct alkalosis, especially, if the most common modalities CVVHDF (continuous veno-venous hemodiafiltration) or CVVHD (continuous veno-venous hemodialysis) are applied.…”