Dokument: A safe and effective protocol for postdilution hemofiltration with regional citrate anticoagulation
| Titel: | A safe and effective protocol for postdilution hemofiltration with regional citrate anticoagulation | |||||||
| URL für Lesezeichen: | https://docserv.uni-duesseldorf.de/servlets/DocumentServlet?id=68253 | |||||||
| URN (NBN): | urn:nbn:de:hbz:061-20250124-123121-1 | |||||||
| Kollektion: | Publikationen | |||||||
| Sprache: | Englisch | |||||||
| Dokumententyp: | Wissenschaftliche Texte » Artikel, Aufsatz | |||||||
| Medientyp: | Text | |||||||
| Autoren: | Dimski, Thomas [Autor] Brandenburger, Timo [Autor] Vollmer, Christian [Autor] Kindgen-Milles, Detlef [Autor] | |||||||
| Dateien: |
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| Stichwörter: | Intensive care medicine, Acute kidney injury, Citrate anticoagulation, Continuous renal replacement therapy, Hemofiltration | |||||||
| Beschreibung: | Background
Regional citrate anticoagulation (RCA) is recommended during continuous renal replacement therapy. Compared to systemic anticoagulation, RCA provides a longer filter lifespan with the risk of metabolic alkalosis and impaired calcium homeostasis. Surprisingly, most RCA protocols are designed for continuous veno-venous hemodialysis or hemodiafiltration. Effective protocols for continuous veno-venous hemofiltration (CVVH) are rare, although CVVH is a standard treatment for high-molecular-weight clearance. Therefore, we evaluated a new RCA protocol for postdilution CVVH. Methods This is a monocentric prospective interventional study to evaluate a new RCA protocol for postdilution CVVH. We recruited surgical patients with stage III acute kidney injury who needed renal replacement therapy. We recorded dialysis and RCA data and hemodynamic and laboratory parameters during treatment sessions of 72 h. The primary endpoint was filter patency at 72 h. The major safety parameters were metabolic alkalosis and severe hypocalcemia at any time. Results We included 38 patients who underwent 66 treatment sessions. The mean filter lifespan was 66 ± 12 h, and 44 of 66 (66%) filters were patent at 72 h. After censoring for non-CVVH-related cessation of treatment, 83% of all filters were patent at 72 h. The delivered dialysis dose was 28 ± 5 ml/kgBW/h. The serum levels of creatinine, urea and beta2-microglobulin decreased significantly from day 0 to day 3. Metabolic alkalosis occurred in one patient. An iCa++ below 1.0 mmol/L occurred in four patients. Citrate accumulation did not occur. Conclusions We describe a safe, effective, and easy-to-use RCA protocol for postdilution CVVH. This protocol provides a long and sustained filter lifespan without serious adverse effects. The risk of metabolic alkalosis and hypocalcemia is low. Using this protocol, a recommended dialysis dose can be safely administered with effective clearance of low- and middle-molecular-weight molecules. | |||||||
| Rechtliche Vermerke: | Originalveröffentlichung:
Dimski, T., Brandenburger, T., Vollmer, C., & Kindgen-Milles, D. (2024). A safe and effective protocol for postdilution hemofiltration with regional citrate anticoagulation. BMC Nephrology, 25, Article 218. https://doi.org/10.1186/s12882-024-03659-y | |||||||
| Lizenz: |  Dieses Werk ist lizenziert unter einer Creative Commons Namensnennung 4.0 International Lizenz | |||||||
| Fachbereich / Einrichtung: | Medizinische Fakultät | |||||||
| Dokument erstellt am: | 24.01.2025 | |||||||
| Dateien geändert am: | 24.01.2025 |
