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.
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
Pregnancy
A known hypersensitivity to citrate compounds
Refusal of informed consent
patients older than 18 years with acute kidney injury requiring continuous renal replacement therapy with reduced of absent citrate metabolism
Cohort
Prospective
continuous renal replacement therapy with regional citrate anticoagulation
DeviceCVVHDF using regional citrate anticoagulation in patients with absent or reduced citrate metabolism
the incidence of citrate intoxication
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
citrate intoxication and need for alternative anticoagulation regime
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