| Continuous veno-venous hemofiltration with regional citrate anticoagulation: a four-year single-center experience. | |
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MedLine Citation:
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PMID: 19089795 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Hemofiltration protocols using a citrate-buffered replacement solution offer the advantage of regional anticoagulation and a buffer effect. The role played by such fluids in clinical practice is not yet well established. The risk of electrolytic disorders, acid-base imbalance, or citrate accumulation should be clarified. We report on a renal therapy protocol based on a citrate isonatremic replacement solution. METHOD: We considered all patients needing renal replacement therapy admitted to our cardiovascular intensive care unit between January 2003 and June 2007. A citrate-buffered fluid was delivered in predilution mode to a post-filter ionized calcium target < or = 0.25 mmol/L. Extracorporeal blood flow was set at a constant of 140+/-10 ml/min. Blood calcemia was maintained by a 5% calcium-chloride solution infused into the patient. We recorded the patients' acid-base variables, ionized calcium, daily electrolytes, albumin, urea and filter life-span. RESULTS: We observed 101 consecutive patients out of 2,523; incidence 4%, overall mortality was 57% at ICU discharge. Mean replacement rate was 2,554+/-475 ml/h corresponding to 34+/-5 ml/kg/h. Mean patient ionized calcium level was 1.07+/-0.04 mmo/L, maintained by 13+/-2 ml/h of infused calcium-chloride. All other electrolytes remained in the normal range. The Stewart biophysical approach confirmed a strong anion gap of 3.1+/- 3 meq/L. Acid-base balance showed a buffer effect. Mean filter life-span was 52+/-11 h. CONCLUSION: Renal replacement therapy based on citrate-buffered fluid may be useful in clinical practice. This methodology presented an adequate metabolic control and allowed regional anticoagulation. A sufficient calcium supply was mandatory to avoid hypocalcemia. The small strong ion gap suggested a modest citrate accumulation. |
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Authors:
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T Cassina; R Mauri; A Engeler; O Giannini |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: The International journal of artificial organs Volume: 31 ISSN: 0391-3988 ISO Abbreviation: Int J Artif Organs Publication Date: 2008 Nov |
Date Detail:
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Created Date: 2008-12-17 Completed Date: 2009-02-19 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 7802649 Medline TA: Int J Artif Organs Country: Italy |
Other Details:
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Languages: eng Pagination: 937-43 Citation Subset: IM |
Affiliation:
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Anesthesia/Intensive Care Unit, Department of Cardiac Anesthesia, Cardiocentro Ticino, Lugano - Switzerland. tiziano.cassina@cardiocentro.org |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Acid-Base Equilibrium
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drug effects* Aged Aged, 80 and over Anticoagulants / administration & dosage*, adverse effects Biological Markers / blood Blood Coagulation / drug effects* Buffers Calcium / blood Calcium Chloride / administration & dosage Citric Acid / administration & dosage*, adverse effects Dialysis Solutions / administration & dosage*, adverse effects Hemofiltration* / instrumentation Humans Isotonic Solutions Membranes, Artificial Middle Aged Serum Albumin / metabolism Time Factors Treatment Outcome Urea / blood |
| Chemical | |
Reg. No./Substance:
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0/Anticoagulants; 0/Biological Markers; 0/Buffers; 0/Dialysis Solutions; 0/Isotonic Solutions; 0/Membranes, Artificial; 0/Serum Albumin; 10043-52-4/Calcium Chloride; 57-13-6/Urea; 7440-70-2/Calcium; 77-92-9/Citric Acid |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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