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Kidney Week

Abstract: PO0074

Sustained Low-Efficiency Dialysis with Regional Citrate Anticoagulation and a Standard Hemodialysis Machine in Critically Ill Patients with AKI

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Di Mario, Francesca, UO Nefrologia, Azienda Ospedaliera-Universitaria Parma, Parma, Italy., Parma, Italy
  • Fani, Filippo Maria, UO Nefrologia e Dialisi, Ospedale San Giovanni di Dio, USL Toscana centro, Firenze, Italy
  • Greco, Paolo, UO Nefrologia, Azienda Ospedaliera-Universitaria Parma, Parma, Italy., Parma, Italy
  • Maccari, Caterina, UO Nefrologia, Azienda Ospedaliera-Universitaria Parma, Parma, Italy., Parma, Italy
  • Parenti, Elisabetta, UO Nefrologia, Azienda Ospedaliera-Universitaria Parma, Parma, Italy., Parma, Italy
  • Di Motta, Tommaso, UO Nefrologia, Azienda Ospedaliera-Universitaria Parma, Parma, Italy., Parma, Italy
  • Farina, Maria Teresa, UO Nefrologia, Azienda Ospedaliera-Universitaria Parma, Parma, Italy., Parma, Italy
  • Regolisti, Giuseppe, UO Nefrologia, Azienda Ospedaliera-Universitaria Parma, Parma, Italy., Parma, Italy
  • Fiaccadori, Enrico, UO Nefrologia, Azienda Ospedaliera-Universitaria Parma, Parma, Italy., Parma, Italy
Background

Sustained-Low Efficiency Dialysis (SLED) is an increasingly used Kidney Replacement Therapy (KRT) modality in critically patients with Acute Kidney Injury (AKI); in this setting regional citrate anticoagulation (RCA) is a rational approach to avoid extracorporeal circuit clotting. The present study was aimed at evaluating the safety and efficacy of a simplified RCA protocol for SLED with a conventional hemodialysis machine.

Methods

SLED was performed for 8-12 hours (daily or every other day) with a Surdial X Nipro® hemodialysis machine and a cellulose triacetate filter (Sureflux-19L, 1.9 m2, KUF 19 ml/mmHg/h). Blood flow was set at 200 ml/min and dialysis fluid flow at 100 ml/min. Citrate was infused in pre-dilution as ACD-A solution (citrate 2.2%, 112.9 mmol/L) at 200-400 ml/h rates (estimated pre-filter citrate concentration 2-4 mmol/L). Treatment was monitored by serial evaluations of ionized calcium (Ca++) and ACT at the beginning, at the 2nd hour and at the end of SLED session. Blood in the extracorporeal circuit was recalcified by the dialysis fluid itself (Ca++ 1.5 mmol/L) through Ca++ backfiltration; i.v. calcium supplementation was started only if patient Ca++ at the 2nd hour was <0.9 mmol/L.

Results

41 SLED sessions were performed in 12 critically ill patients with AKI (mean age 69 + 18 SD, mean APACHE II 22). Average pre- and post-SLED urea values were respectively 94 and 32 mg/dL. Most sessions (38/41, 93%) were completed for elapsed prescribed time. No statistically significant differences were observed between systemic ACT values measured during SLED as compared to baseline values. Ca supplementation (10% Ca gluconate at fixed rate 5 ml/hour) was needed in 10/41 treatments, with rapid normalization of serum Ca++. No new cardiac arrhythmia episode or hemorrhagic events were observed.

Conclusion

Our preliminary data suggests that a simplified RCA protocol for SLED using a conventional dialysis machine is easy and safe, also ensuring a good match between prescribed and actual dialysis dose administered.