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Regional citrate anti-coagulation dose titration: impact on dose of continuous renal replacement therapy.
Ng, Charles Jun Han; Poh, Cheng Boon; Koduri, Sreekanth; Roy, Debajyoti Malakar; Siau, Chuin; Lim, Noelle Louise; Chionh, Chang Yin.
Afiliación
  • Ng CJH; Department of Renal Medicine, Changi General Hospital, 2 Simei Street 3, Singapore, 529889, Singapore.
  • Poh CB; SingHealth Residency (Renal Medicine), Singapore Health Services, Singapore, Singapore.
  • Koduri S; Department of Renal Medicine, Changi General Hospital, 2 Simei Street 3, Singapore, 529889, Singapore.
  • Roy DM; Department of Renal Medicine, Changi General Hospital, 2 Simei Street 3, Singapore, 529889, Singapore.
  • Siau C; Department of Renal Medicine, Changi General Hospital, 2 Simei Street 3, Singapore, 529889, Singapore.
  • Lim NL; Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore, Singapore.
  • Chionh CY; Department of Anaesthesia and Surgical Intensive Care, Changi General Hospital, Singapore, Singapore.
Clin Exp Nephrol ; 25(9): 963-969, 2021 Sep.
Article en En | MEDLINE | ID: mdl-33885995
BACKGROUND: Regional citrate anti-coagulation (RCA) is the recommended anti-coagulation for continuous renal replacement therapy (CRRT). Citrated replacement fluids provide convenience but may compromise effluent delivery when adjusted to maintain circuit ionised calcium levels (circuit-iCa). This study aims to evaluate the effect of RCA titration on the delivered CRRT effluent dose. METHODS: This prospective observational study evaluated patients on RCA-CRRT in continuous veno-venous hemodiafiltration mode. Citrated replacement fluid was titrated to target circuit-iCa 0.26-0.40 mmol/L. Patients were then stratified into 'reduced-dose' who required citrate down-titration and 'stable-dose' who did not. RESULTS: Data from 200 RCA-CRRT sessions were collected. The reduced-dose RCA group (n = 114) had higher median initial citrate dose (3.00 vs 2.50; P < 0.001) but lower time-averaged dose (2.49 vs 2.60; P < 0.001). In addition, median prescribed effluent dose was 33.3 mL/kg/h (28.6-39.2) but median delivered effluent dose was significantly lower at 29.9 mL/kg/h (25.4-36.9; P < 0.001). Mortality was higher in the reduced-dose RCA group (39.5% vs 25.6%; P = 0.022) and in patients with delivered-to-prescribed effluent dose ratio of < 0.9 vs ≥ 0.9 (51.3% vs 29.2%; P = 0.014). CONCLUSION: RCA titration can significantly impact delivered CRRT effluent dose. Measures should be taken to address the CRRT dose deficit and prevent poor outcomes due to inadequate dialysis.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Ácido Cítrico / Insuficiencia Renal / Terapia de Reemplazo Renal Continuo / Anticoagulantes Tipo de estudio: Observational_studies Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Clin Exp Nephrol Asunto de la revista: NEFROLOGIA Año: 2021 Tipo del documento: Article País de afiliación: Singapur Pais de publicación: Japón
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Ácido Cítrico / Insuficiencia Renal / Terapia de Reemplazo Renal Continuo / Anticoagulantes Tipo de estudio: Observational_studies Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Clin Exp Nephrol Asunto de la revista: NEFROLOGIA Año: 2021 Tipo del documento: Article País de afiliación: Singapur Pais de publicación: Japón