None listed
Conditions
Brief summary
Acute kidney injury is common in critically ill patients and hence continuous renal replacement therapy (CRRT) is an important treatment modality in intensive care. Clotting of the circuit is a major factor contributed to treatment interruption. Regional citrate anticoagulation (RCA) for CRRT is associated with longer filter-life, less bleeding events and improved mortality. We previously reported the use of the Prismocitate 10/2 with good metabolic control and median circuit filter life range from 50 to 26 hrs. Yet, hypomagnesaemia (41.6%) and hypophosphatemia (17.6%) were two commonly encountered electrolyte anomalies during citrate CRRT. Besides, additional sodium bicarbonate infusion was used in all the patients to provide adequate buffer balance. To circumvent all these problems, another proprietary citrate containing solution (Prismocitrate 18/0, Gambro) and phosphate containing hemofiltration solution (Phoxilim) had been used in combination with success in a number of studies. We would like to assess whether or not the combined used of these solutions can provide a safe and effective alternative for critically ill patients who required CRRT.
Interventions
Citrate CVVH was performed using either of the following 2 machines: Prismaflex machine (Gambro-Hospal) with a high-flux hemofilter (HF 1400/ ST 100) or MultiFiltrate (Fresenius Medical Care) with the Ultraflux AV 600S hemofilter. The blood flow rate was maintained at 110ml/min, Prismocitrate 18/0 solution running at a fixed rate of 1250 ml/h as predilution replacement fluid, Phoxilium solution at 1250ml/h as post-dilution replacement fluid. Blood samples for urea/ creatinine/ acid-base/ total
Citrate CVVH was performed using either of the following 2 machines: Prismaflex machine (Gambro-Hospal) with a high-flux hemofilter (HF 1400/ ST 100) or MultiFiltrate (Fresenius Medical Care) with the Ultraflux AV 600S hemofilter. The blood flow rate was maintained at 110ml/min, Prismocitrate 18/0 solution running at a fixed rate of 1250 ml/h as predilution replacement fluid, Phoxilium solution at 1250ml/h as post-dilution replacement fluid. Blood samples for urea/ creatinine/ acid-base/ total calcium/ ionized calcium/ pre-filter ionzied calcium/ post-filter ionized calcium were taken at time 0, 2, 4, 8, 16, 24, 32, 40, 48, 56, 64 and 72hrs for monitoring purpose. Additional blood tests were performed as indicated based on clinical indications. Concentrated calcium infusion (10% Calcium chloride) was infused via a separate central line and was titrated to achieve a systemic iCa level of 1–1.2 mmol/L. The fluid withdrawal rate was adjusted to achieve the desired fluid balance. The circuit was run for 72 h unless there was filter clotting, transportation outside ICU, or the patient did not require additional CRRT.
Sponsors
Intensive Care Unit, Queen Elizabeth Hospital
Eligibility
Sex/Gender
All
Age
18 Years to 85 Years
Healthy volunteers
No
Inclusion criteria
All patients who underwent CVVH using Prismocitrate 18/0 and Phoxilium during the study period
Exclusion criteria
Insufficient data for analysis
Outcome results
None listed