Regional Citrate Anticoagulatinln for Continuous Renal Replacement Therapy in Children

Hahn, Hye-Won; Park, Young-Seo

J Korean Soc Pediatr Nephrol > Volume 9(1); 2005 > Article

J Korean Soc Pediatr Nephrol 2005;9(1): 76-82.

소아의 지속적 신대체요법에서 Citrate 항응고요법의 경험

한혜원, 박영서

¹을지의과대학교 을지병원 소아과, 울산대학교 의과대학 서울아산병원 소아과
²울산대학교 의과대학 서울아산병원 소아과

Regional Citrate Anticoagulatinln for Continuous Renal Replacement Therapy in Children

Hye-Won Hahn, Young-Seo Park

¹Deparrmenr of Pediatrics, Eulji university, Eulji Medical Cener, Depatrment, of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center
²Departmenf of Pediatrics, Uniuersity of Ulsan College of Medicine Asan Medical

ABSTRACT

Purpose : Regional anticoagulation with trisodium citrate for continuous renal replacement therapy(CRRT) is an effective and safe method, with lower bleeding risk. However it is not widely used because of complex current protocols used to prevent anticipated metabolic derangements. We evaluated simplified regional anticoagulation protocols with ACD-A(R) solution and commercially available calcium-containing dialysis solution.
Methods : The medical records of twenty-eight patients who underwent CRRT were reviewed. Hemofilter life span according to the anticoagulation method used was compared, and laboratory findings at Pre- and 48 hours post-CRRT initiation were compared in the citrate-based CRRT group.
Results : Of the twenty-eight Patients, five patients underwent citrate-based CRRT Hemofilter life span was 1.60 $pm$ 0.72 days, showing no significant differences with the hemofilter life span in the heparin based and LMWH based CRRT group. No patients experienced hemorrhagic complications. PT, aPTT, sodium, t$CO_{2}$, iCa levels showed no difference in pre- and post-CRRT. Total calcium levels were increased. At the recommended postfilter iCa level, j.e., 0.25-0.39 mmol/L, all five patients needed increased amount of citrate infusion, and Ca infusion requirement was decreased.
Conclusion : Simplified regional citrate anticoagulation with calcium-containing dialysate is an effective and safe method, and is not associated with increased hemofilter clotting. However, increased postfilter iCa level is recommended.

Key words: Calcium containing dialysate | Citrate anticoagulation | Children | CRRT