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Abstract: PO0097

Safety and Efficacy of a New Simplified Regional Citrate Anticoagulation Protocol for Continuous Venovenous Hemodiafiltration and Sustained Low-Efficiency Dialysis Focused on Acid-Base Balance Optimization and Prevention of Kidney Replacement Therapy-Induced Hypophosphatemia

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Di Mario, Francesca, UO Nefrologia, Azienda Ospedaliera-Universitaria Parma, Parma, Italy
  • Greco, Paolo, UO Nefrologia, Azienda Ospedaliera-Universitaria Parma, Parma, Italy
  • Maccari, Caterina, UO Nefrologia, Azienda Ospedaliera-Universitaria Parma, Parma, Italy
  • Parenti, Elisabetta, UO Nefrologia, Azienda Ospedaliera-Universitaria Parma, Parma, Italy
  • Rossi, Giovanni maria, UO Nefrologia, Azienda Ospedaliera-Universitaria Parma, Parma, Italy
  • Pistolesi, Valentina, Umberto I Policlinico di Roma, Roma, Lazio, Italy
  • Morabito, Santo, Umberto I Policlinico di Roma, Roma, Lazio, Italy
  • Fiaccadori, Enrico, UO Nefrologia, Azienda Ospedaliera-Universitaria Parma, Parma, Italy

Group or Team Name

  • Nephrology Unit, Parma University Hospital, Parma, Italy
Background

Regional citrate anticoagulation (RCA) is the first-line anticoagulation strategy for Kidney Replacement Therapy (KRT) in Acute Kidney Injury (AKI). Hypophosphatemia is a common electrolyte disorder in the ICU, especially in course of prolonged and highly efficient KRTs. This pilot study is aimed at evaluating a simplified RCA protocol for Continuous Venovenous Hemodiafiltration (CVVHDF) and Sustained Low Efficiency Dialysis (SLED), based on the combination of a low-concentration citrate solution with a phosphate-containing solution.

Methods

KRT was performed in ICU patients with AKI by the Prismax system (Baxter) and polyacrylonitrile AN69 filters (ST 150, 1.5 m2, Baxter), combining a 18 mmol/l pre-dilution trisodium citrate solution (Regiocit 18/0, Baxter) with a phosphate-containing solution used as both dialysate and post-dilution replacement (Ca2+ 0, HPO42 - 1, Mg2+ 0.75, HCO3- 22 mmol/l; Biphozyl, Baxter). Calcium chloride (CaCl 10%) was infused in a central venous line to maintain the systemic Ca2+ within a normal range. In each patient three consecutive daily 8-h SLED sessions or 72-h CVVHDF were evaluated. Phosphorus (P) losses were replaced, when needed, with sodium glycerophosphate pentahydrate (GlycophosTM 20 mmol/20 ml, Fresenius Kabi Norge AS, Halden, Norvegia).

Results

20 patients with AKI on SLED and 10 on CVVHDF were studied (mean APACHE II score 23.8). No premature interruptions for irreversible filter clotting occurred; prescribed dialysis dose was delivered in 95% of cases. No statistically significant differences were observed between systemic ACT measured at KRT start and at different times during KRT. No major hemorrhagic events nor clinically relevant episodes of hypo- or hypercalcemia were observed. Acid-base status and serum phosphorus levels were effectively maintained.

Conclusion

Our simplified RCA protocol is safe and efficacious both for SLED and CVVHDF, allowing to optimizing acid-base balance and to preventing KRT-related hypophosphatemia.