Continuous venovenous hemofiltration with or without predilution regional citrate anticoagulation: a prospective study.

A B Johan Groeneveld, Pieter M Ter Wee, Marc G Vervloet, S Azam Nurmohamed, Armand R J Girbes

Journal: Blood purification 2007;25(4):316-23

PMID: 17700015

Full Text on S. Karger AG, Basel, Switzerland View on PubMed

Abstract

BACKGROUND/AIMS

Continuous venovenous hemofiltration (CVVH) requires anticoagulation to prevent circuit clotting and its use is contraindicated in patients with high bleeding risk. The aim of this study was to compare CVVH with and without regional citrate anticoagulation (RCA) with respect to filter life, azotemic control and cost.

METHODS

This was a prospective sequential cohort study. The first cohort of patients with a high bleeding risk and acute renal failure was treated by anticoagulant-free predilution CVVH (n = 31). In the second cohort, CVVH was applied with RCA (n = 20).

RESULTS

The median filter life was 41 h (interquartile range 20-62) with RCA and 12 h (8-28) without RCA (p = 0.001). The azotemic control was better in the group with RCA. The hourly cost was comparable between the two groups.

CONCLUSION

Regional anticoagulation with citrate-based replacement solution improved filter life compared to anticoagulant-free predilution CVVH. This regimen appeared safe, feasible and without metabolic complications or increased costs.

Address: Department of Nephrology, VU University Medical Center, Amsterdam, The Netherlands. [email protected]

DOI: 10.1159/000107045

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https://doi.org/10.1159/000107045

MeSH Terms: Acute Kidney Injury, Aged, Anticoagulants, Calcium, Citrates, Cohort Studies, Critical Care, Equipment Failure, Female, Hemofiltration, Hemorrhage, Hemorrhagic Disorders, Humans, Male, Middle Aged, Prospective Studies, Sodium Citrate, Solutions