Efficacy and safety of a citrate-based protocol for sustained low-efficiency dialysis in AKI using standard dialysis equipment
Clinical Journal of the American Society of Nephrology, ISSN: 1555-9041, Vol: 8, Issue: 10, Page: 1670-1678
2013
- 61Citations
- 48Captures
- 1Mentions
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Metrics Details
- Citations61
- Citation Indexes61
- 61
- CrossRef46
- Captures48
- Readers48
- 48
- Mentions1
- News Mentions1
- 1
Most Recent News
Quality indicators in prolonged hemodialysis with regional citrate anticoagulation with the genius system: retrospective cohort of critical patients with acute kidney injury
Abstract Background Prolonged hemodialysis (HD) is performed from 6 to 12 h and can last up to 24 h. To prevent system clotting some studies suggest that
Article Description
Background and objectives A simple anticoagulation protocol was developed for sustained low-efficiency dialysis (SLED) in patients with AKI, based on the use of anticoagulant citrate dextrose solution formulation A (ACD-A) and standard dialysis equipment. Patients' blood recalcification was obtained from calcium backtransport from dialysis fluid. Design, setting, participants, & measurements All patients treated with SLED (8-to 12-hour sessions) for AKI in four intensive care units of a university hospital were studied over a 30-month period, from May 1, 2008 to September 30, 2010. SLED interruptions and their causes, hemorrhagic complications, as well as coagulation parameters, ionized calcium, and blood citrate levels were recorded. Results This study examined 807 SLED sessions in 116 patients (mean age of 69.7 years [SD 12.1]; mean Acute Physiology and Chronic Health Evaluation II score of 23.8 [4.6]). Major bleeding was observed in six patients (5.2% or 0.4 episodes/100 person-days follow-up while patients were on SLED treatment). Citrate accumulation never occurred, even in patients with liver dysfunction. Intravenous calcium for ionized hypocalcemia (< 3.6 mg/dl or < 0.9 mmol/L) was needed in 28 sessions (3.4%); in 8 of these 28 sessions (28.6%), low ionized calcium was already present before SLED start. In 92.6% of treatments, SLED was completed within the scheduled time (median 8 hours). Interruptions of SLED by impending/irreversible clotting were recorded in 19 sessions (2.4%). Blood return was complete in 98% of the cases. In-hospital mortality was 45 of 116 patients (38.8%). Conclusions This study protocol affords efficacious and safe anticoagulation of the SLED circuit, avoiding citrate accumulation and, in most patients, systematic calcium supplementation; it can be implemented with commercial citrate solutions, standard dialysis equipment, on-line produced dialysis fluid, and minimal laboratory monitoring. © 2013 by the American Society of Nephrology.
Bibliographic Details
http://www.scopus.com/inward/record.url?partnerID=HzOxMe3b&scp=84885236919&origin=inward; http://dx.doi.org/10.2215/cjn.00510113; http://www.ncbi.nlm.nih.gov/pubmed/23990164; https://journals.lww.com/01277230-201310000-00007; http://cjasn.asnjournals.org/cgi/doi/10.2215/CJN.00510113; https://syndication.highwire.org/content/doi/10.2215/CJN.00510113; http://dx.doi.org/10.2215/CJN.00510113; https://dx.doi.org/10.2215/CJN.00510113; https://journals.lww.com/cjasn/fulltext/2013/10000/efficacy_and_safety_of_a_citrate_based_protocol.7.aspx; https://cjasn.asnjournals.org/content/8/10/1670; https://cjasn.asnjournals.org/content/8/10/1670.abstract; https://cjasn.asnjournals.org/content/8/10/1670.full.pdf; http://cjasn.asnjournals.org/lookup/doi/10.2215/CJN.00510113; https://cjasn.asnjournals.org/content/clinjasn/8/10/1670.full.pdf; http://europepmc.org/abstract/med/23990164; http://europepmc.org/articles/PMC3789332; http://cjasn.asnjournals.org/content/8/10/1670
Ovid Technologies (Wolters Kluwer Health)
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