Simplified regional citrate anticoagulation protocol for CVVH, CVVHDF and SLED focused on the prevention of KRT-related hypophosphatemia while optimizing acid-base balance

Autor: Francesca Di Mario, Alice Sabatino, Giuseppe Regolisti, Maria Chiara Pacchiarini, Paolo Greco, Caterina Maccari, Giuseppe Vizzini, Chiara Italiano, Valentina Pistolesi, Santo Morabito, Enrico Fiaccadori
Rok vydání: 2023
Předmět:
Zdroj: Nephrology Dialysis Transplantation.
ISSN: 1460-2385
0931-0509
0397-6440
Popis: Background Hypophosphatemia is a common electrolyte disorder in critically ill patients undergoing prolonged Kidney Replacement Therapy (KRT). We evaluated the efficacy and safety of a simplified Regional Citrate Anticoagulation (RCA) protocol for Continuous Venovenous Hemofiltration (CVVH), Continuous Venovenous Hemodiafiltration (CVVHDF) and Sustained Low Efficiency Dialysis Filtration (SLED-f). We aimed at preventing KRT-related hypophosphatemia while optimizing acid-base equilibrium. Methods KRT was performed by the Prismax system (Baxter) and polyacrylonitrile AN69 filters (ST 150, 1.5 m2, Baxter), combining a 18 mmol/l pre-dilution citrate solution (Regiocit 18/0, Baxter) with a phosphate-containing solution (HPO42− 1.0 mmol/L, HCO3− 22.0 mmol/L; Biphozyl, Baxter). When needed, phosphate loss was replaced with sodium glycerophosphate pentahydrate (GlycophosTM 20 mmol/20 ml, Fresenius Kabi Norge AS, Halden, Norway). Serum citrate measurements were scheduled during each treatment. We analyzed data from three consecutive daily 8-h SLED-f sessions, as well as single 72-h CVVH or 72-h CVVHDF sessions. We used analysis of variance (ANOVA) for repeated measures to evaluate differences in variables means (i.e. serum phosphate, citrate). Because some patients received phosphate supplementation, we performed analysis of covariance (ANCOVA) for repeated measures modelling phosphate supplementation as a covariate. Results 47 patients with Acute Kidney Injury (AKI) or End Stage Kidney Disease (ESKD) requiring KRT were included (11 CVVH, 11 CVVHDF, and 25 SLED-f sessions; mean APACHE II score 25 ± 7.0). Interruptions for irreversible filter clotting were negligible. The overall incidence of hypophosphatemia (s-P levels Conclusions Our data obtained with a new simplified RCA protocol suggest that it is effective and safe for CVVH, CVVHDF and SLED, allowing to prevent KRT-related hypophosphatemia and maintain the acid-base balance without citrate accumulation. Trial registration: NCT03976440 registered June 6, 2019.
Databáze: OpenAIRE
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