Acute Renal Failure, Citrate Poisoning, Dialysis; Complications
Conditions
Keywords
sodium citrate, calcaemia, magnesium, phosphorus, ionic calcium
Brief summary
The investigators designed a monitoring and control table of a citrate treatment on a specific monitor. This is the Baxter Prismaflex monitor, with 8.2 software version. Dialysis bath liquids marketed by Baxter: Biphozyl are used. Citrate liquid (1:18) Regiocit is used. The dialysis treatment monitor (CVVHD) is programmed, with a blood / citrate pumps at a rate of 1:10 (1 ml / min of blood: 10 ml / h of dialysis fluid) The starting dose of citrate will be 3.5 mmol / l and the calcium compensation will be 100% Working hypothesis: The patient undergoing citrate anticoagulation according to the designed algorithm will respond with ion stability and pH during the treatment, in addition to achieving an effective cleaning process.
Detailed description
Study design: quasi-experimental design. two groups: 1. Usual protocol with Multifiltrate monitor and citrate (136 mmol/l) 2. Intervention group. New protocol with Prismaflex monitor and citrate (18 mmol/l) Study population Inclusión/exclusion criteria: Adult patients (regardless of their underlying pathology), who develop acute renal failure, admitted to the ICU of St Pau Hospital with the Intensive Medicine medical team, who require citrate anticoagulation in continuous dialysis therapy and are treated with Baxter Prismaflex monitor. Patients who meet the criteria described above will be followed up in this study. Expected sample size: It is estimated that with 24/12 (group1/2) patients will be enough to achieve our goal Methodology. Information sources: The start of the treatment with Baxter citrate will be given according to the patient's need and subject to a basic medical decision. From here the research team will enter. The investigation team will never influence the medical decision. Since such a treatment is started, the main investigator will assign a number to the dialysis circuit and will be followed, every six hours, for the most important variables. The rest of the variables will be collected at least once a day and according to the patient's situation.
Interventions
OTHERthe same citrate dosification in both types
match concentrated and dilute citrate protocol
Sponsors
Fundació Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau
Study design
Allocation
NON_RANDOMIZED
Intervention model
SEQUENTIAL
Primary purpose
TREATMENT
Masking
SINGLE (Investigator)
Intervention model description
Quasi-experimental design
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adult patients (regardless of their underlying pathology), who develop acute renal failure, admitted to the ICU of St Pau with the medical team of Intensive Medicine, who require anticoagulation with citrate in continuous dialysis therapy and are treated with the Baxter monitor.
Exclusion criteria
* parenteral nutrition * pregnancy * cardiac surgery * coronary patients
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Dialysis flow | 6 hours | Speed at which the dialysis fluid pump is programmed in the circuit and measured in milliliters / hour |
| Blood flow | 6 hours | Speed at which the blood pump is programmed in the dialysis circuit and measured in milliliters / min |
| Citrate dose | 6 hours | Relationship that exists between the liquid we infuse (which contains 18mmol / L citrate) and the blood pump. It is measured in mmol citrate / liter of blood |
| Calcium dose | 6 hours | Amount of calcium that is replenished to the patient when the dialyzed blood is returned. It is measured in%. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Potassium | 24 hours | Value of this ion in the patient. It is measured in mmol / l. |
| Urea | 24 hours | Urea level of the patient at the time of observation |
| Filter operating hours | number of hours | They correspond to the hours that go from the beginning of the circuit until the end of the circuit in which the fungible is discarded. It can be several days |
| Arterial pH | 6 hours | Corresponds to the patient's arterial blood pH figure at the time of observation |
| Arterial bicarbonate | 6 hours | It is the bicarbonate figure found in arterial blood. It is measured in mmol / l. |
| Creatinine | 24 hours | Creatinine level of the patient at the time of observation |
| Ionic Calcium Patien | 6 hours | It is the ionic calcium value of the patient in a systemic way, preferably arterial. It is measured in mmol / l |
| Total calcium | 6 hours | Total calcium value. It is measured in mmol / l |
| Total Ca / Ionic Ca Ratio | 24 hours | Relationship between the total calcium and the ionic one of the patient |
| Match | 24 hours | Value of this ion in the patient. It is measured in mmol / l. |
| Magnesium | 24 hours | Value of this ion in the patient. It is measured in mmol / l. |
| Post-filter ionic calcium | 6 hours | Corresponds to the value of ionic calcium by taking the sample at the blood outlet of the dialysis filter. It is measured in mmol / l. |
| INR | 24 hours | INR level of the patient at the time of observation |
| Lactate | 24 hours | Lactate level of the patient at the time of observation |
| Sodium | 24 hours | Value of this ion in the patient. It is measured in mmol / l. |
Countries
Spain
Outcome results
None listed