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Implementation of continuous renal replacement therapy with regional citrate anticoagulation on a surgical and trauma intensive care unit: impact on clinical and economic aspects—an observational study

BACKGROUND: Regional citrate anticoagulation (RCA) is being increasingly used during continuous renal replacement therapy (CRRT) in intensive care units as an alternative to systemic heparin anticoagulation. However, due to its availability in a variety of solutions and dialysis systems, RCA is stil...

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Autores principales: Hafner, Sebastian, Stahl, Wolfgang, Fels, Theresa, Träger, Karl, Georgieff, Michael, Wepler, Martin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4520083/
https://www.ncbi.nlm.nih.gov/pubmed/26229685
http://dx.doi.org/10.1186/s40560-015-0102-7
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author Hafner, Sebastian
Stahl, Wolfgang
Fels, Theresa
Träger, Karl
Georgieff, Michael
Wepler, Martin
author_facet Hafner, Sebastian
Stahl, Wolfgang
Fels, Theresa
Träger, Karl
Georgieff, Michael
Wepler, Martin
author_sort Hafner, Sebastian
collection PubMed
description BACKGROUND: Regional citrate anticoagulation (RCA) is being increasingly used during continuous renal replacement therapy (CRRT) in intensive care units as an alternative to systemic heparin anticoagulation. However, due to its availability in a variety of solutions and dialysis systems, RCA is still considered a complex intervention, possibly leading to confusion and pitfalls in everyday practice. We therefore tested retrospectively if the introduction of RCA as a new anticoagulation strategy for CRRT was feasible and had not negatively impacted efficacy, safety, metabolic stability, filter lifetime, and cost-effectiveness compared to well-established systemic heparin. METHODS: This observational, retrospective study was performed on a non-cardiac surgical and trauma intensive care unit (ICU) in a university hospital. All charts of patients receiving one of the CRRT techniques from May 2006 to April 2010 were reviewed. The first 60 consecutive patients receiving CRRT with regional citrate anticoagulation after its implementation in February 2008 (continuous veno-venous haemodialysis, Multifiltrate® with integrated CiCa® system, AV 1000 S® filter, n = 60) were included in the study. The last 50 consecutive patients with systemic heparin anticoagulation therapy (continuous veno-venous haemodiafiltration, PRISMAFLEX®, AN69® filter, n = 50), treated immediately before the introduction of RCA, were used as a historic control group. RESULTS: Both treatment modalities were effective in terms of uraemia control. Patients in the citrate group presented with significantly higher pH levels, lower ionized calcium levels, and higher sodium levels compared with the heparin treated group, however, without notable adverse clinical events. Interestingly, mean circuit lifetime was significantly longer in the citrate group (48.6 ± 24.2 h vs. 18.8 ± 13.5 h; p < 0.0001). Both treatment modalities were cost-effective. CONCLUSIONS: Our results suggest that the implementation of regional citrate anticoagulation was safe and effective. Due to the retrospective design of the study and inherent limitations therein concerning several baseline parameters, i.e. different filters, modes of dialysis, and flow parameters not having been standardized, we were unable to draw a causative effect relationship. Nonetheless, our results warrant further study.
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spelling pubmed-45200832015-07-31 Implementation of continuous renal replacement therapy with regional citrate anticoagulation on a surgical and trauma intensive care unit: impact on clinical and economic aspects—an observational study Hafner, Sebastian Stahl, Wolfgang Fels, Theresa Träger, Karl Georgieff, Michael Wepler, Martin J Intensive Care Research BACKGROUND: Regional citrate anticoagulation (RCA) is being increasingly used during continuous renal replacement therapy (CRRT) in intensive care units as an alternative to systemic heparin anticoagulation. However, due to its availability in a variety of solutions and dialysis systems, RCA is still considered a complex intervention, possibly leading to confusion and pitfalls in everyday practice. We therefore tested retrospectively if the introduction of RCA as a new anticoagulation strategy for CRRT was feasible and had not negatively impacted efficacy, safety, metabolic stability, filter lifetime, and cost-effectiveness compared to well-established systemic heparin. METHODS: This observational, retrospective study was performed on a non-cardiac surgical and trauma intensive care unit (ICU) in a university hospital. All charts of patients receiving one of the CRRT techniques from May 2006 to April 2010 were reviewed. The first 60 consecutive patients receiving CRRT with regional citrate anticoagulation after its implementation in February 2008 (continuous veno-venous haemodialysis, Multifiltrate® with integrated CiCa® system, AV 1000 S® filter, n = 60) were included in the study. The last 50 consecutive patients with systemic heparin anticoagulation therapy (continuous veno-venous haemodiafiltration, PRISMAFLEX®, AN69® filter, n = 50), treated immediately before the introduction of RCA, were used as a historic control group. RESULTS: Both treatment modalities were effective in terms of uraemia control. Patients in the citrate group presented with significantly higher pH levels, lower ionized calcium levels, and higher sodium levels compared with the heparin treated group, however, without notable adverse clinical events. Interestingly, mean circuit lifetime was significantly longer in the citrate group (48.6 ± 24.2 h vs. 18.8 ± 13.5 h; p < 0.0001). Both treatment modalities were cost-effective. CONCLUSIONS: Our results suggest that the implementation of regional citrate anticoagulation was safe and effective. Due to the retrospective design of the study and inherent limitations therein concerning several baseline parameters, i.e. different filters, modes of dialysis, and flow parameters not having been standardized, we were unable to draw a causative effect relationship. Nonetheless, our results warrant further study. BioMed Central 2015-07-30 /pmc/articles/PMC4520083/ /pubmed/26229685 http://dx.doi.org/10.1186/s40560-015-0102-7 Text en © Hafner et al. 2015 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Hafner, Sebastian
Stahl, Wolfgang
Fels, Theresa
Träger, Karl
Georgieff, Michael
Wepler, Martin
Implementation of continuous renal replacement therapy with regional citrate anticoagulation on a surgical and trauma intensive care unit: impact on clinical and economic aspects—an observational study
title Implementation of continuous renal replacement therapy with regional citrate anticoagulation on a surgical and trauma intensive care unit: impact on clinical and economic aspects—an observational study
title_full Implementation of continuous renal replacement therapy with regional citrate anticoagulation on a surgical and trauma intensive care unit: impact on clinical and economic aspects—an observational study
title_fullStr Implementation of continuous renal replacement therapy with regional citrate anticoagulation on a surgical and trauma intensive care unit: impact on clinical and economic aspects—an observational study
title_full_unstemmed Implementation of continuous renal replacement therapy with regional citrate anticoagulation on a surgical and trauma intensive care unit: impact on clinical and economic aspects—an observational study
title_short Implementation of continuous renal replacement therapy with regional citrate anticoagulation on a surgical and trauma intensive care unit: impact on clinical and economic aspects—an observational study
title_sort implementation of continuous renal replacement therapy with regional citrate anticoagulation on a surgical and trauma intensive care unit: impact on clinical and economic aspects—an observational study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4520083/
https://www.ncbi.nlm.nih.gov/pubmed/26229685
http://dx.doi.org/10.1186/s40560-015-0102-7
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