Use of regional citrate anticoagulation for continuous venovenous hemodialysis in critically ill cancer patients with acute kidney injury

Silva, Verônica Torres Costa e; Caires, Renato Antunes; Bezerra, Juliana Silva; Costalonga, Elerson Carlos; Oliveira, Ana Paula Leandro; Coelho, Fernanda Oliveira; Fukushima, Júlia Tizue; Soares, Cilene Muniz; Oikawa, Luciane; Hajjar, Ludhmila Abrahão; Burdmann, Emmanuel A.

doi:10.1016/j.jcrc.2018.04.006

Cited by 4 publications

(7 citation statements)

References 39 publications

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“…Therefore, with the ACD-A solution-based RCA protocol, low-sodium substitution fluid is not required to prevent hypernatraemia. The 2.4% incidence of hypernatraemia observed in our group during CRRT treatment was lower than observed with protocols based on tri-sodium citrate solutions used for CVVHD (Costa et al, 2018).…”

Section: Discussioncontrasting

confidence: 70%

“…Metabolic alkalosis during CRRT was more common in our study (25.2%) than in earlier studies on RCA for CVVHD: 14% observed in cancer patients (Costa et al, 2018) and 5% observed in ICU patients (Borg et al, 2017;Khadzhynov et al, 2017). However, this overcompensation of metabolic acidosis with the simplified CVVH RCA protocol might be beneficial in patients who were acidotic at the beginning of CRRT.…”

Section: Discussioncontrasting

confidence: 68%

“…He also reported severe hypocalcaemia (<0.9 mmol/L) in three patients (20%), while in our group, we reported severe hypocalcaemia in 11 patients (22%), which was equal to 4.9% of all readings. Hypercalcaemia was observed more often before than during haemofiltration in the present cohort (4.9% of all readings during CVVH), and the incidence was higher than those previously reported from CVVHD and CVVHDF studies (2-2.5%) (Costa et al, 2018;Khadzhynov et al, 2017). The incidence of severe hypercalcaemia (0.7%) in our group was, however, lower than the 2% incidence observed by Khadzhynov and others (Khadzhynov et al, 2017).…”

Section: Discussioncontrasting

confidence: 66%

“…In the studied patients, other indirect features of CA, such as escalating calcium requirements and the development of HAGMA, were rarely observed, making the diagnosis of citrate toxicity questionable. In the present study, the incidence of a high tCa/iCa ratio during haemofiltration treatment (4.6%) was higher than that observed during RCA for CVVHD, when it did not exceed 2.3 in any patient (Costa et al, 2018).…”

Section: Discussioncontrasting

confidence: 65%

“…In our group, the magnesium level in the serum decreased over time during treatment with CVVH with A-CDA RCA and significant hypomagnesaemia developed after 48 hours of CVVH, despite routine magnesium sulfate supplementation at a rate of 0.81 mmol/hour. In this study hypomagnesaemia was more common (22.3%) than previously reported from the CVVHD RCA study in cancer patients with AKI (2.3%) (Costa et al, 2018). It was proposed that the magnesium concentration in substitution fluids used in ICU patients should be supra-normal rather than subnormal to compensate for increased losses due to its chelation by citrate (Zakcharchenko et al, 2016).…”

Section: Discussionmentioning

confidence: 63%

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Ionic homeostasis, acid-base balance and the risk of citrate accumulation in patients after cardiovascular surgery treated with continuous veno-venous haemofiltration with post-dilution regional citrate anticoagulation – An observational case-control stud

et al. 2021

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Background: Patients after cardiovascular surgery, requiring renal replacement therapy, can benefit from adequate non-heparin circuit anticoagulation. Simplified regional citrate anticoagulation (RCA) protocol proposes the use of citric acid dextrose formula A (ACD-A) during post-dilutional continuous veno-venous hemofiltration (CVVH) with standard bicarbonate buffered calcium containing replacement solution. Citrate accumulation diagnosed upon total to ionized calcium ratio (tCa/iCa) and low ionized calcium (iCa) are considered as the biggest risks related to regional citrate accumulation. Methods: This prospective observational case-control study evaluated electrolyte and acid-base homeostasis in cardiovascular surgery patients treated with post-dilution CVVH with a simplified RCA protocol with ACD-A. In total, 50 consecutive cardiovascular surgery patients were evaluated. Base excess, pH, bicarbonate, lactate, Na+, Cl-, Mg++, and inorganic phosphate concentrations, the total to ionized calcium ratio (tCa/iCa), and high anion gap metabolic acidosis were assessed during haemofiltration treatment in survivors and non-survivors. Results: Thirty-three (66%) patients died. The therapies were very well balanced in sodium and chloride homeostasis. The lactate concentration and anion gap decreased during CVVH sessions lasting longer than 72 hours, but no inter-group difference was observed. The tCa/iCa ratio exceeded 4.5% and was significantly higher in non-survivors (p=0.037). Initial lactate concentration did not correlate with tCa/iCa ratio during haemofiltration. Magnesium and phosphate concentrations decreased and additional supplementation with magnesium was necessary. The magnesium concentration was lower in the non-survivors. Conclusions: The incidence of citrate accumulation exceeded 4% and was significantly higher in non-survivors. Supplementation with magnesium and phosphate ions is needed in CVVH with RCA.

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Section: Discussioncontrasting

confidence: 70%