Intensive monitoring of post filter ionized calcium concentrations during CVVHD with regional citrate anticoagulation: A retrospective study

Dmytro Khadzhynov; Jonas Deissler; Otajon Bobonov; Christin Schelter; Harm Peters; Detlef Kindgen-Milles; Klemens Budde; Lukas Johannes Lehner; Fabian Halleck; Oliver Staeck; Kai-Uwe Eckardt; Torsten Slowinski

doi:10.1016/j.jcrc.2020.03.002

Intensive monitoring of post filter ionized calcium concentrations during CVVHD with regional citrate anticoagulation: A retrospective study

J Crit Care. 2020 Aug:58:1-5. doi: 10.1016/j.jcrc.2020.03.002. Epub 2020 Mar 4.

Authors

Affiliations

¹ Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Charitéplatz 1, 10117 Berlin, Germany. Electronic address: [email protected].
² Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Charitéplatz 1, 10117 Berlin, Germany. Electronic address: [email protected].
³ Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Charitéplatz 1, 10117 Berlin, Germany. Electronic address: [email protected].
⁴ Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Charitéplatz 1, 10117 Berlin, Germany. Electronic address: [email protected].
⁵ Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Charitéplatz 1, 10117 Berlin, Germany. Electronic address: [email protected].
⁶ Department of Anesthesiology, University Hospital Duesseldorf, Heinrich-Heine-University, Germany. Electronic address: [email protected].
⁷ Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Charitéplatz 1, 10117 Berlin, Germany. Electronic address: [email protected].
⁸ Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Charitéplatz 1, 10117 Berlin, Germany. Electronic address: [email protected].
⁹ Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Charitéplatz 1, 10117 Berlin, Germany. Electronic address: [email protected].
¹⁰ Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Charitéplatz 1, 10117 Berlin, Germany. Electronic address: [email protected].
¹¹ Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Charitéplatz 1, 10117 Berlin, Germany. Electronic address: [email protected].
¹² Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Charitéplatz 1, 10117 Berlin, Germany. Electronic address: [email protected].

PMID: 32244094
DOI: 10.1016/j.jcrc.2020.03.002

Abstract

Background: The aim of the present study was to assess the predictive value of post-filter ionized calcium (pfCa) levels for filter-clotting during continuous veno-venous hemodialysis (CVVHD) with regional citrate anticoagulation (RCA).

Methods: Retrospective analysis of a database derived from 6 intensive care units (ICU) at a university hospital. During the 3-year period 1070 patients were treated with RCA-CVVHD with a citrate starting dose of 4 mmol/L blood and a target-range for pfCa of 0.25-0.35 mmol/L.

Results: The pfCa concentrations at RCA-CVVHD initiation were within the target range in 69.7% of patients. Within 12 h the fraction of patients with pfCa above target-range decreased significantly from 13.1% to 7.8% (p < .001). There was no significant difference in filter survival between patients with a pfCa initially below, within, or above the target-range (83.7%, 89.5% and 90.4%; p = .228) and no significant correlation between the last pfCa and the incidence of filter clotting (rho 0.018, p = .572 and -0.054, p = .104; respectively).

Conclusions: CVVHD with a citrate starting dose of 4 mmol/L blood resulted in a pfCa within target in the majority of patients. The observation that pfCa was not associated with the incidence of circuit clotting suggests that less frequent measurements of pfCA might be safe.

Keywords: Continuous renal replacement therapy; Filter clotting; Ionized calcium; POCT; Post-filter calcium; Regional citrate anticoagulation.

MeSH terms

Adult
Anticoagulants / administration & dosage
Anticoagulants / therapeutic use*
Blood Coagulation
Calcium / blood*
Calcium Citrate / administration & dosage
Calcium Citrate / therapeutic use*
Continuous Renal Replacement Therapy*
Female
Humans
Intensive Care Units
Kidney Failure, Chronic / therapy*
Male
Monitoring, Physiologic
Predictive Value of Tests
Retrospective Studies

Substances

Anticoagulants
Calcium Citrate
Calcium