Continuous venovenous haemofiltration with citrate-buffered replacement solution is safe and efficacious in patients with a bleeding tendency: a prospective observational study
Open Access
- 18 April 2013
- journal article
- Published by Springer Science and Business Media LLC in BMC Nephrology
- Vol. 14 (1), 89
- https://doi.org/10.1186/1471-2369-14-89
Abstract
There is ongoing controversy concerning optimum anticoagulation and buffering in continuous venovenous haemofiltration (CVVH). Regional anticoagulation with trisodium citrate also acting as a buffer in the replacement fluid has several advantages and disadvantages over prefilter citrate administration alone. We analysed a large cohort of patients with acute kidney injury (AKI) treated by the former method and hypothesized that it is safe and efficacious. Patients admitted at the intensive care unit with AKI and a high bleeding risk, without exclusion of liver disease, treated by CVVH with citrate in a custom-made replacement solution were prospectively included. Patient and CVVH characteristics, including citrate accumulation, were evaluated in outcome groups. A standardized mortality rate (SMR) was calculated using the simplified acute physiology score II. Ninety-seven patients were included; metabolic control was adequate and did not differ between outcome groups, apart from lower pH/bicarbonate in non-survivors. Citrate accumulation was proven in 9% and was timely identified. These patients had about threefold higher plasma transaminases and higher CVVH dose and mortality. The hospital mortality was 60% with a SMR of 1.1 (95% confidence interval 0.90-1.40): age and hyperlactatemia, rather than CVVH-characteristics and citrate accumulation, predicted mortality in multivariable analysis. In critically ill, patients with AKI at high risk of bleeding, CVVH with citrate-containing replacement solution is safe and efficacious. The risk for citrate accumulation is 9% and best predicted by levels of transaminases. It carries, when citrate is discontinued, no attributable mortality.Keywords
This publication has 29 references indexed in Scilit:
- Regional citrate anticoagulation in cardiac surgery patients at high risk of bleeding: a continuous veno-venous hemofiltration protocol with a low concentration citrate solutionCritical Care, 2012
- Total-to-ionized calcium ratio predicts mortality in continuous renal replacement therapy with citrate anticoagulation in critically ill patientsCritical Care, 2012
- Predilution versus Postdilution Continuous Venovenous Hemofiltration: No Effect on Filter Life and Azotemic Control in Critically Ill Patients on HeparinASAIO Journal, 2011
- Clinical review: Anticoagulation for continuous renal replacement therapy - heparin or citrate?Critical Care, 2010
- A safe citrate anticoagulation protocol with variable treatment efficacy and excellent control of the acid–base status*Critical Care Medicine, 2009
- Citrate anticoagulation for continuous venovenous hemofiltration*Critical Care Medicine, 2009
- Continuous Venovenous Hemofiltration with or without Predilution Regional Citrate Anticoagulation: A Prospective StudyBlood Purification, 2007
- A NOVEL METHOD FOR REGIONAL CITRATE ANTICOAGULATION IN CONTINUOUS VENOVENOUS HEMOFILTRATION (CVVHF)Renal Failure, 2002
- Regional citrate anticoagulation in continuous venovenous hemofiltration in critically ill patients with a high risk of bleedingKidney International, 1999
- Regional citrate anticoagulation for continuous arteriovenous hemodialysis in critically ill patientsKidney International, 1990