Acute Kidney Injury
Conditions
Keywords
Acute kidney injury, Regional citrate anticoagulation, citrate metabolism
Brief summary
Use of regional citrate anticoagulation in an at risk population with decreased citrate metabolism. This study assesses the feasibility and safety of regional citrate anticoagulation in this population.
Detailed description
Regional citrate anticoagulation (RCA) is the recommended anticoagulation strategy for continuous renal replacement therapy (CRRT). Traditionally, CRRT-RCA is not recommended in patients with advanced liver failure or in patients with severe hemodynamic shock due to the risk of citrate accumulation or citrate intoxication. However, since more than a decade more and more patients with advanced liver failure and severe hemodynamic shock undergo safely CRRT-RCA with an adapted CRRT protocol. The aim of this study is to evaluate the efficacy and safety of CRRT-RCA in patients with decreased citrate metabolism using an adapted protocol to maximize citrate elimination.
Interventions
CVVHDF using regional citrate anticoagulation in patients with absent or reduced citrate metabolism
Sponsors
University Hospital, Antwerp
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Need for renal replacement therapy in the ICU with any of the following criteria: * anticipation of severely impaired citrate metabolism (serum lactate ≥ 5 mmol/l in patients with shock or requirement of a dextrose drip to prevent hypoglycemia or spontaneous INR \> 3 and/or requirement of fresh frozen plasma to maintain INR \< 3 in patients with cirrhosis or acute liver failure or acute on chronic liver failure) * development of citrate toxicity under CRRT with RCA due to worsening citrate metabolism
Exclusion criteria
* Pregnancy * A known hypersensitivity to citrate compounds * Refusal of informed consent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| the incidence of citrate intoxication | 96 hours | a. Citrate accumulation defined as a total/ionized calcium ratio \> 2,5 b. Citrate intoxication is defined as i. Total/ionized calcium \> 2,5 in combination with two of the following 1. Ionized calcium \< 0,8 in spite of calcium substitution 2. Increasing demand in calcium substitution during the last 8 hours 3. Presence of high anion gap metabolic acidosis |
| the incidence of refractory citrate intoxication | 96 hours | citrate intoxication and need for alternative anticoagulation regime |
Countries
Belgium
Contacts
CONTACTwalter verbrugghe, MD
CONTACTRita Jacobs, MD
Outcome results
None listed