Regional Citrate Anticoagulation in Predilution Continuous Venovenous Hemofiltration Using Prismocitrate 10/2 Solution

摘要

Regional citrate anticoagulation (RCA) for continuous renal replacement therapy (CRRT) is associated with a longer filter life and fewer bleeding events. Complexity of the regimen is the major hurdle preventing widespread application. This study describes a simple predilution continuous venovenous hemofiltration (CVVH) protocol utilizing a commercially prepared replacement solution containing citrate (Prismocitrate10/2). Ten patients with acute renal failure were evaluated. The Prismaflex system was used for predilution CVVH, with Prismocitrate10/2 running at 2500mL/h as the main predilution replacement. An 8.4% sodium bicarbonate solution was infused at 50mL/h in the first 2h followed by 30mL/h; 10% calcium gluconate was given to achieve an ionized calcium (iCa) level of 1-1.2mmol/L. The circuit was run for 72h unless there was filter clotting, transportation was required, or the patient did not require further CRRT. Total treatment duration was 504.5h. The post-dilution equivalent ultrafiltration rate was 32.9mL/kg/h (interquartile range [IQR] 31.6-38.2) and the median circuit life was 50.3h (IQR 25.5-72.0). None of the circuit was changed due to circuit clotting. The median systemic iCa was 0.98mmol/L (IQR 0.91-1.08). The total calcium-to-iCa ratio was 2.33 (IQR 2.21-2.45). None of the patients developed hypernatremia (Na≥150mmol/L) or citrate toxicity (total Ca-to-iCa ratio>2.5 plus increasing metabolic acidosis), and metabolic alkalosis (pH≥7.5) occurred in one patient. This simple RCA CVVH protocol using commercially-prepared solution could be a feasible, relatively safe, and effective alternative to the conventional regimen for patients with a body weight up to 80kg.