In:
Hemodialysis International, Wiley, Vol. 17, No. 2 ( 2013-04), p. 313-320
Abstract:
Regional citrate anticoagulation ( RCA ) is a valid anticoagulation method in continuous renal replacement therapies ( CRRT ) and different combination of citrate and CRRT solutions can affect acid‐base balance. Regardless of the anticoagulation protocol, hypophosphatemia occurs frequently in CRRT . In this case report, we evaluated safety and effects on acid‐base balance of a new RCA‐ continuous veno‐venous hemofiltration (CVVH ) protocol using an 18 mmol/L citrate solution combined with a phosphate‐containing replacement fluid. In our center, RCA‐CVVH is routinely performed with a 12 mmol/L citrate solution and a postdilution replacement fluid with bicarbonate (protocol A ). In case of persistent acidosis, not related to citrate accumulation, bicarbonate infusion is scheduled. In order to optimize buffers balance, a new protocol has been designed using recently introduced solutions: 18 mmol/L citrate solution, phosphate‐containing postdilution replacement fluid with bicarbonate (protocol B ). In a cardiac surgery patient with acute kidney injury, acid‐base status and electrolytes have been evaluated comparing protocol A (five circuits, 301 hours) vs. protocol B (two circuits, 97 hours): pH 7.39 ± 0.03 vs. 7.44 ± 0.03 (P 〈 0.0001), bicarbonate 22.3 ± 1.8 vs. 22.6 ± 1.4 mmol/L ( NS ), Base excess −2.8 ± 2.1 vs. −1.6 ± 1.2 (P = 0.007), phosphate 0.85 ± 0.2 vs. 1.3 ± 0.5 mmol/L (P = 0.027). Protocol A required bicarbonate and sodium phosphate infusion (8.9 ± 2.8 mmol/h and 5 g/day, respectively) while protocol B allowed to stop both supplementations. In comparison to protocol A , protocol B allowed to adequately control acid‐base status without additional bicarbonate infusion and in absence of alkalosis, despite the use of a standard bicarbonate concentration replacement solution. Furthermore, the combination of a phosphate‐containing replacement fluid appeared effective to prevent hypophosphatemia.
Type of Medium:
Online Resource
ISSN:
1492-7535
,
1542-4758
DOI:
10.1111/hdi.2013.17.issue-2
DOI:
10.1111/j.1542-4758.2012.00730.x
Language:
English
Publisher:
Wiley
Publication Date:
2013
detail.hit.zdb_id:
2103570-2
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