J Korean Soc Pediatr Nephrol.  2005 Apr;9(1):76-82.

Regional Citrate Anticoagulation for Continuous Renal Replacement Therapy in Children

• Hahn H
• Park YS

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.

Keyword

Calcium containing dialysate; Citrate anticoagulation; Children; CRRT

MeSH Terms

Calcium
Child*
Citric Acid*
Dialysis
Hemorrhage
Heparin
Heparin, Low-Molecular-Weight
Humans
Medical Records
Renal Replacement Therapy*
Sodium
Calcium
Citric Acid
Heparin
Heparin, Low-Molecular-Weight
Sodium