Safety and Feasibility of Regional Citrate Anticoagulation for Continuous Renal Replacement Therapy With Calcium-Containing Solutions: A Randomized Controlled Trial.
calcium-containing solutions
continuous renal replacement therapy
metabolic complications
regional citrate anticoagulation
thrombus
Journal
Seminars in dialysis
ISSN: 1525-139X
Titre abrégé: Semin Dial
Pays: United States
ID NLM: 8911629
Informations de publication
Date de publication:
05 Mar 2024
05 Mar 2024
Historique:
revised:
10
10
2023
received:
14
08
2023
accepted:
02
02
2024
medline:
5
3
2024
pubmed:
5
3
2024
entrez:
5
3
2024
Statut:
aheadofprint
Résumé
Calcium-free (Ca-free) solutions are theoretically the most ideal for regional citrate anticoagulation (RCA) in continuous renal replacement therapy (CRRT). However, the majority of medical centers in China had to make a compromise of using commercially available calcium-containing (Ca-containing) solutions instead of Ca-free ones due to their scarcity. This study was designed to probe into the potential of Ca-containing solution as a secure and efficient substitution for Ca-free solutions. In this prospective, randomized single-center trial, 99 patients scheduled for CRRT were randomly assigned in a 1:1:1 ratio to one of three treatment groups: continuous veno-venous hemodialysis Ca-free dialysate (CVVHD Ca-free) group, continuous veno-venous hemodiafiltration calcium-free dialysate (CVVHDF Ca-free) group, and continuous veno-venous hemodiafiltration Ca-containing dialysate (CVVHDF Ca-containing) group at cardiac intensive care unit (CICU). The primary endpoint was the incidence of metabolic complications. The secondary endpoints included premature termination of treatment, thrombus of filter, and bubble trap after the process. The incidence of citrate accumulation (18.2% vs. 12.1% vs. 21.2%) and metabolic alkalosis (12.1% vs. 0% vs. 9.1%) did not significantly differ among three groups (p > 0.05 for both). The incidence of premature termination was comparable among the groups (18.2% vs. 9.1% vs. 9.1%, p = 0.582). The thrombus level of the filter and bubble trap was similar in the three groups (p > 0.05 for all). In RCA-CRRT for CICU population, RCA-CVVHDF with Ca-containing solutions and traditional RCA with Ca-free solutions had a comparable safety and feasibility. ChiCTR2100048238 in the Chinese Clinical Trial Registry.
Sections du résumé
BACKGROUND
BACKGROUND
Calcium-free (Ca-free) solutions are theoretically the most ideal for regional citrate anticoagulation (RCA) in continuous renal replacement therapy (CRRT). However, the majority of medical centers in China had to make a compromise of using commercially available calcium-containing (Ca-containing) solutions instead of Ca-free ones due to their scarcity. This study was designed to probe into the potential of Ca-containing solution as a secure and efficient substitution for Ca-free solutions.
METHODS
METHODS
In this prospective, randomized single-center trial, 99 patients scheduled for CRRT were randomly assigned in a 1:1:1 ratio to one of three treatment groups: continuous veno-venous hemodialysis Ca-free dialysate (CVVHD Ca-free) group, continuous veno-venous hemodiafiltration calcium-free dialysate (CVVHDF Ca-free) group, and continuous veno-venous hemodiafiltration Ca-containing dialysate (CVVHDF Ca-containing) group at cardiac intensive care unit (CICU). The primary endpoint was the incidence of metabolic complications. The secondary endpoints included premature termination of treatment, thrombus of filter, and bubble trap after the process.
RESULTS
RESULTS
The incidence of citrate accumulation (18.2% vs. 12.1% vs. 21.2%) and metabolic alkalosis (12.1% vs. 0% vs. 9.1%) did not significantly differ among three groups (p > 0.05 for both). The incidence of premature termination was comparable among the groups (18.2% vs. 9.1% vs. 9.1%, p = 0.582). The thrombus level of the filter and bubble trap was similar in the three groups (p > 0.05 for all).
CONCLUSIONS
CONCLUSIONS
In RCA-CRRT for CICU population, RCA-CVVHDF with Ca-containing solutions and traditional RCA with Ca-free solutions had a comparable safety and feasibility.
TRIAL REGISTRATION
BACKGROUND
ChiCTR2100048238 in the Chinese Clinical Trial Registry.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Xiamen Science and Technology Project
ID : 3502Z20184028
Organisme : Science and Technology Projects of Fujian Province
ID : 2022D028
Organisme : National Natural Science Foundation of China
ID : 81900365
Informations de copyright
© 2024 The Authors. Seminars in Dialysis published by Wiley Periodicals LLC.
Références
C. Ronco and Z. Ricci, “Renal Replacement Therapies: Physiological Review,” Intensive Care Medicine 34, no. 12 (2008): 2139-2146.
R. Bellomo, J. Raman, and C. Ronco, “Intensive Care Unit Management of the Critically Ill Patient With Fluid Overload after Open Heart Surgery,” Cardiology 96, no. 3-4 (2001): 169-176.
C. Ronco, “Evolution of Technology for Continuous Renal Replacement Therapy: Forty Years of Improvement,” Contributions to Nephrology 194 (2018): 1-14.
“Summary of Recommendation Statements,” Kidney International. Supplement (2011) 2, no. 1 (2012): 8-12.
M. Monchi, D. Berghmans, D. Ledoux, J. L. Canivet, B. Dubois, and P. Damas, “Citrate vs. Heparin for Anticoagulation in Continuous Venovenous Hemofiltration: A Prospective Randomized Study,” Intensive Care Medicine 30, no. 2 (2004): 260-265.
M. Bai, M. Zhou, L. He, et al., “Citrate Versus Heparin Anticoagulation for Continuous Renal Replacement Therapy: An Updated Meta-Analysis of RCTs,” Intensive Care Medicine 41, no. 12 (2015): 2098-2110.
H. M. Oudemans-van Straaten, “Citrate Anticoagulation for Continuous Renal Replacement Therapy in the Critically Ill,” Blood Purification 29, no. 2 (2010): 191-196.
S. Morgera, M. Schneider, T. Slowinski, et al., “A Safe Citrate Anticoagulation Protocol With Variable Treatment Efficacy and Excellent Control of the Acid-Base Status,” Critical Care Medicine 37, no. 6 (2009): 2018-2024.
P. D. Brophy, M. J. Somers, M. A. Baum, et al., “Multi-Centre Evaluation of Anticoagulation in Patients Receiving Continuous Renal Replacement Therapy (CRRT),” Nephrology, Dialysis, Transplantation 20, no. 7 (2005): 1416-1421.
A. G. Schneider, D. Journois, and T. Rimmele, “Complications of Regional Citrate Anticoagulation: Accumulation or Overload?” Critical Care 21, no. 1 (2017): 281.
R. Murugan, E. Hoste, R. L. Mehta, et al., “Precision Fluid Management in Continuous Renal Replacement Therapy,” Blood Purification 42, no. 3 (2016): 266-278.
F. Sigwalt, A. Bouteleux, F. Dambricourt, T. Asselborn, F. Moriceau, and T. Rimmele, “Clinical Complications of Continuous Renal Replacement Therapy,” Contributions to Nephrology 194 (2018): 109-117.
R. L. Mehta, B. R. McDonald, M. M. Aguilar, and D. M. Ward, “Regional Citrate Anticoagulation for Continuous Arteriovenous Hemodialysis in Critically Ill Patients,” Kidney International 38, no. 5 (1990): 976-981.
L. Zhang, Y. Liao, J. Xiang, et al., “Simplified Regional Citrate Anticoagulation Using a Calcium-Containing Replacement Solution for Continuous Venovenous Hemofiltration,” Journal of Artificial Organs 16, no. 2 (2013): 185-192.
S. C. Ong, K. M. Wille, R. Speer, and A. J. Tolwani, “A Continuous Veno-Venous Hemofiltration Protocol With Anticoagulant Citrate Dextrose Formula a and a Calcium-Containing Replacement Fluid,” The International Journal of Artificial Organs 37, no. 6 (2014): 499-502.
C. J. Kirwan, R. Hutchison, S. Ghabina, et al., “Implementation of a Simplified Regional Citrate Anticoagulation Protocol for Post-Dilution Continuous Hemofiltration Using a Bicarbonate Buffered, Calcium Containing Replacement Solution,” Blood Purification 42, no. 4 (2016): 349-355.
A. Karkar and C. Ronco, “Prescription of CRRT: A Pathway to Optimize Therapy,” Annals of Intensive Care 10, no. 1 (2020): 32.
S. Verma and P. M. Palevsky, “Prescribing Continuous Kidney Replacement Therapy in Acute Kidney Injury: A Narrative Review,” Kidney Medicine 3, no. 5 (2021): 827-836.
J. O. Friedrich, R. Wald, S. M. Bagshaw, K. E. Burns, and N. K. Adhikari, “Hemofiltration Compared to Hemodialysis for Acute Kidney Injury: Systematic Review and Meta-Analysis,” Critical Care 16, no. 4 (2012): R146.
M. Gupta, N. K. Wadhwa, and R. Bukovsky, “Regional Citrate Anticoagulation for Continuous Venovenous Hemodiafiltration Using Calcium-Containing Dialysate,” American Journal of Kidney Diseases 43, no. 1 (2004): 67-73.
O. Cointault, N. Kamar, P. Bories, et al., “Regional Citrate Anticoagulation in Continuous Venovenous Haemodiafiltration Using Commercial Solutions,” Nephrology, Dialysis, Transplantation 19, no. 1 (2004): 171-178.
H. Rhee, B. Berenger, R. L. Mehta, and E. Macedo, “Regional Citrate Anticoagulation for Continuous Kidney Replacement Therapy With Calcium-Containing Solutions: A Cohort Study,” American Journal of Kidney Diseases 78, no. 4 (2021): 550-559 e551.
T. Wei, X. Tang, L. Zhang, et al., “Calcium-Containing Versus Calcium-Free Replacement Solution in Regional Citrate Anticoagulation for Continuous Renal Replacement Therapy: A Randomized Controlled Trial,” Chinese Medical Journal 135, no. 20 (2022): 2478-2487.
D. Kindgen-Milles, T. Brandenburger, and T. Dimski, “Regional Citrate Anticoagulation for Continuous Renal Replacement Therapy,” Current Opinion in Critical Care 24, no. 6 (2018): 450-454.
M. Balik, M. Zakharchenko, P. Leden, et al., “Bioenergetic Gain of Citrate Anticoagulated Continuous Hemodiafiltration-A Comparison Between 2 Citrate Modalities and Unfractionated Heparin,” Journal of Critical Care 28, no. 1 (2013): 87-95.
M. Legrand and A. Tolwani, “Anticoagulation Strategies in Continuous Renal Replacement Therapy,” Seminars in Dialysis 34, no. 6 (2021): 416-422.
S. Morabito, V. Pistolesi, L. Tritapepe, and E. Fiaccadori, “Regional Citrate Anticoagulation for RRTs in Critically Ill Patients With AKI,” Clinical Journal of the American Society of Nephrology 9, no. 12 (2014): 2173-2188.
W. Zhang, M. Bai, Y. Yu, et al., “Safety and Efficacy of Regional Citrate Anticoagulation for Continuous Renal Replacement Therapy in Liver Failure Patients: A Systematic Review and Meta-Analysis,” Critical Care 23, no. 1 (2019): 22.
E. Macedo and R. L. Mehta, “Continuous Dialysis Therapies: Core Curriculum 2016,” American Journal of Kidney Diseases 68, no. 4 (2016): 645-657.
J. Buturovic-Ponikvar, S. Cerne, J. Gubensek, and R. Ponikvar, “Regional Citrate Anticoagulation for Hemodialysis: Calcium-Free vs. Calcium Containing Dialysate - a Randomized Trial,” The International Journal of Artificial Organs 31, no. 5 (2008): 418-424.