Regional Citrate Anticoagulation for Continuous Renal Replacement Therapy in Children.
- Author:
Hyewon HAHN
1
;
Young Seo PARK
Author Information
1. Department of Pediatrics, Eulji University, Eulji Medical Cener, Asan Medical Center, Seoul, Korea.
- Publication Type:Original Article
- Keywords:
Calcium containing dialysate;
Citrate anticoagulation;
Children;
CRRT
- MeSH:
Calcium;
Child*;
Citric Acid*;
Dialysis;
Hemorrhage;
Heparin;
Heparin, Low-Molecular-Weight;
Humans;
Medical Records;
Renal Replacement Therapy*;
Sodium
- From:Journal of the Korean Society of Pediatric Nephrology
2005;9(1):76-82
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: Regional anticoagulation with trisodium citrate for continuous renal replacement therapy(CRRT) is an effective and safe method, with lower bleeding risk. However it is not widely used because of complex current protocols used to prevent anticipated metabolic derangements. We evaluated simplified regional anticoagulation protocols with ACD-A(R) solution and commercially available calcium-containing dialysis solution. METHODS: The medical records of twenty-eight patients who underwent CRRT were reviewed. Hemofilter life span according to the anticoagulation method used was compared, and laboratory findings at pre- and 48 hours post-CRRT initiation were compared in the citrate-based CRRT group. RESULTS: Of the twenty-eight patients, five patients underwent citrate-based CRRT. Hemofilter life span was 1.60+/-0.72 days, showing no significant differences with the hemofilter life span in the heparin based and LMWH based CRRT group. No patients experienced hemorrhagic complications. PT, aPTT, sodium, tCO2, iCa levels showed no difference in pre- and post-CRRT. Total calcium levels were increased. At the recommended postfilter iCa level, i.e., 0.25-0.39 mmol/L, all five patients needed increased amount of citrate infusion, and Ca infusion requirement was decreased. CONCLUSION: Simplified regional citrate anticoagulation with calcium-containing dialysate is an effective and safe method, and is not associated with increased hemofilter clotting. However, increased postfilter iCa level is recommended.
