SP241
SIMPLIFIED REGIONAL CITRATE ANTICOAGULATION USING A CALCIUM-CONTAINING REPLACEMENT SOLUTION FOR CONTINUOUS RENAL REPLACEMENT THERAPY: A RANDOMIZED PROSPECTIVE PILOT TRIAL Free

INTRODUCTION AND AIMS: A simplified protocol for Regional citrate anticoagulation (RCA) using a commercial calcium-containing replacement solution, without a continuous calcium infusion, is more efficient to be used in continuous renal replacement therapy (CRRT). We aim to design a randomized prospective pilot trial to compare the safety and efficacy between calcium-free and calcium-containing replacement solution in CRRT with RCA.

METHODS: Twenty eight patients with AKI requiring CRRT were treated with RCA-based continuous venovenous hemodiafiltration and randomized to either group A: calcium-containing or group B: calcium-free replacement solution group. Time spend on fluids preparation before CRRT and the amount of 4% trisodium citrate solution pumped during CRRT were recorded. Serum and effluent citrate concentration during continuous venovenous hemodiafiltration (CVVHDF) were measured during CRRT. Primary endpoints were filter lifespan. Secondary endpoints were kidney function recovery and severe complications.

RESULTS: The mean preparation time before CRRT in group A: 26.5 minutes, was significantly shorter than group B: 48.7 minutes (p<0.001). The serum and effluent citrate concentration had no difference between two groups (p > 0.05). Mean 4 % trisodium citrate solution pumped was 151.11 mL/h in group A and 156.36 in B. Filter lifespans were 30.9 versus 36.2 hrs in group A and B. Kidney function recovery rates were 33.3% in A and 42.8% in B. Only two showed the symptoms and signs of hypocalcemia or citrate toxicity in this study.

CONCLUSIONS: Patients treated with calcium-containing or calcium-free replacement solution have similar clinical outcomes. Since the calcium-containing replacement solution obviates the need for a separate venous catheter and intravenous calcium preparation for continuous intravenous calcium infusion, it is more efficient to be used in clinical practice and superior to the calcium-free replacement solution.