The use of regional citrate anticoagulation for continuous venovenous hemodiafiltration in acute kidney injury

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dc.contributor.authorDurao, Marcelino S. [UNIFESP]
dc.contributor.authorMonte, Julio C. M. [UNIFESP]
dc.contributor.authorBatista, Marcelo C. [UNIFESP]
dc.contributor.authorOliveira, Moacir
dc.contributor.authorLizuka, Llson J.
dc.contributor.authorSantos, Bento F. [UNIFESP]
dc.contributor.authorPereira, Virgilio G.
dc.contributor.authorCendoroglo, Miguel [UNIFESP]
dc.contributor.authorSantos, Oscar F. P. [UNIFESP]
dc.contributor.institutionHosp Israelita Albert Einstein
dc.contributor.institutionUniversidade Federal de São Paulo (UNIFESP)
dc.date.accessioned2016-01-24T13:51:52Z
dc.date.available2016-01-24T13:51:52Z
dc.date.issued2008-11-01
dc.description.abstractObjective. Continuous renal replacement therapy is commonly used in the treatment of acute kidney injury. Although the optimal anticoagulation system is not well defined, citrate has emerged as the most promising method. We evaluated the data of 143 patients with acute kidney injury subjected to citrate-based continuous venovenous hemodiafiltration.Design: Retrospective cohort study.Setting. Intensive care unit of tertiary care private hospital.Patients. Patients with acute kidney injury treated from February 2004 to July 2006.Interventions: None.Measurements and Main Results: the main cause of acute kidney injury was sepsis (58%). the mean dialysis dose was 36.6 mL/kg/hr allowing for excellent metabolic control (last tests: creatinine, 1.1 mg/dL; urea, 46 mg/dL). No significant bleeding, severe electrolyte, or calcium disorders were observed. of the 418 filters used, almost 28,000 hrs of treatment, hemofilter patency was 68% at 72 hrs. Hospital mortality was 59%, and 22% of survivors were dialysis-dependent at the time of discharge. Within our sample, we identified 21 patients with liver failure (mean prothrombin time index, 21% vs. 67%, p < 0.001). This group presented with a lesser median systemic ionized calcium level (1.06 vs. 1.12 mmol/L, p < 0.001) and similar mean total calcium level (8.5 vs. 8.6 mg/dL, not significant), compared with patients without liver failure. These subjects also showed acidemia (median pH, 7.31 vs. 7.40, p < 0.001); however, they exhibited higher levels of lactate (median 29 vs. 16 mg/dL, p < 0.001), chloride (mean 109 vs. 107 mEq/L, p = 0.045) and had a trend to higher mortality rate (76% vs. 56%).Conclusions. Besides a trend toward higher mortality rate observed in the group with liver failure, we found that citrate-based continuous venovenous hemodialfiltration allowed an effective dialysis dose and reasonable filter patency. (Crit Care Med 2008; 36:3024-3029)en
dc.description.affiliationHosp Israelita Albert Einstein, Intens Care Unit, São Paulo, Brazil
dc.description.affiliationHosp Israelita Albert Einstein, Nephrol Support Grp, São Paulo, Brazil
dc.description.affiliationHosp Israelita Albert Einstein, Dialysis Unit, São Paulo, Brazil
dc.description.affiliationUniversidade Federal de São Paulo, Div Nephrol, São Paulo, Brazil
dc.description.affiliationUnifespUniversidade Federal de São Paulo, Div Nephrol, São Paulo, Brazil
dc.description.sourceWeb of Science
dc.format.extent3024-3029
dc.identifierhttp://dx.doi.org/10.1097/CCM.0b013e31818b9100
dc.identifier.citationCritical Care Medicine. Philadelphia: Lippincott Williams & Wilkins, v. 36, n. 11, p. 3024-3029, 2008.
dc.identifier.doi10.1097/CCM.0b013e31818b9100
dc.identifier.issn0090-3493
dc.identifier.urihttp://repositorio.unifesp.br/handle/11600/31020
dc.identifier.wosWOS:000260694200010
dc.language.isoeng
dc.publisherLippincott Williams & Wilkins
dc.relation.ispartofCritical Care Medicine
dc.rightsinfo:eu-repo/semantics/restrictedAccess
dc.subjectacute kidney injuryen
dc.subjectcitrateen
dc.subjectanticoagulationen
dc.subjecthemodiafiltrationen
dc.subjectcontinuous venovenous hemodiafiltrationen
dc.subjectcontinuous renal replacement therapyen
dc.titleThe use of regional citrate anticoagulation for continuous venovenous hemodiafiltration in acute kidney injuryen
dc.typeinfo:eu-repo/semantics/article
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