It is unclear whether different modes of continuous renal replacement therapy (CRRT) impact post-filter ionized calcium concentrations during regional citrate anticoagulation (RCA) when using calcium-containing replacement fluid.
This prospective, single-center, observational cohort study will screen all patients receiving CRRT for eligibility. General clinical information will be collected before commencing CRRT treatment. Patients will be randomly assigned to either the veno-venous hemofiltration (CVVH) or continuous veno-venous hemodialysis (CVVHD) group and switch to the alternative mode in the subsequent treatment session. Pre-filter and post-filter ionized calcium, systemic total and ionized calcium, and effluent total and ionized calcium will be measured 2 hours after the initiation of CRRT. Electrolyte levels, arterial blood gases, hourly citrate dose, and total citrate dose will be recorded every 6 hours until the end of CRRT. The primary outcome is the difference in ionized calcium concentrations at each site over time between the two modes.
Age ≥ 18 years old;
Receiving citrate anticoagulation;
Obtain Informed consent from patients or next of kin.
Pregnant or lactating women;
Allergic to citrate anticoagulants;
Severe liver dysfunction (total bilirubin levels exceeding two times the normal range);
Hypoxemia (PaO2 < 60 mmHg);
All patients admitted to the ICU who need RCA-CRRT will be screened for study eligibility.
Case-crossover
Prospective
CVVH
Procedure/SurgeryCVVH therapy
CVVHD
Procedure/SurgeryCVVHD therapy
Post-filter iCa
The post-filter ionized calcium concentration
Serum iCa
Serum ionized calcium concentration
Serum Ca2+
Serum total calcium concentration
Effluent Ca2+
Effluent total calcium concentration
Incidence of new-onset metabolic complications
Including hypercalcemia, hypocalcemia, metabolic acidosis, metabolic alkalosis, citrate accumulation, hypernatremia, and hyponatremia
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