Comparison of diluted vs concentrated regional citrate anticoagulation in continuous renal replacement therapy : A quasi-experimental study
Mateos-Dávila, Almudena (Institut d'Investigació Biomèdica Sant Pau)
Betbesé Roig, Antoni Jordi (Institut d'Investigació Biomèdica Sant Pau)
Santos, José Alberto (Institut d'Investigació Biomèdica Sant Pau)
Guix-Comellas, Eva Maria (Universitat de Barcelona)
Universitat Autònoma de Barcelona

Fecha:	2023
Resumen:	The incidence of coagulation of continuous renal replacement therapy circuits remains high. To the best of our knowledge, no scholar has published a protocol to avoid management errors when different types of citrates coexist in the same Intensive Care Unit. To assess the safety and efficacy of the unification of two protocols with different concentrations of citrate solution. Study Desing: A prospective, quasi-experimental study was carried out in the intensive care unit of a tertiary referral hospital (in Barcelona, Spain), over 3 years. Consecutive adult patients requiring continuous renal replacement therapy with citrate were included. The sample was divided into two groups, a control group (concentrated citrate) and an intervention group (diluted citrate). The decision to initiate anticoagulation with diluted (18 mmol/L) or concentrated (136 mmol/L) citrate was made based on the machine available and the decision of the doctor responsible for the patient. It was not possible to randomize the sample. Both protocols were matched with a starting citrate dose of 3. 5 mmol/L, and a dialysis solution was used. Post-filter replacement was not used, and the citrate solution was the only fluid administered pre-filter. The analysis included 59 circuits in the concentrated citrate group and 40 circuits in the diluted citrate group. An increased need for electrolyte replacement was observed in the diluted group (p <. 001). The concentrated citrate group had a longer filter life (p <. 05), and there was a slight trend toward alkalosis. The diluted citrate group had a higher incidence of electrolyte replacement. The concentrated citrate group had longer circuit lifespan and a trend toward metabolic alkalosis, although this was not statistically significant. If these conclusions are considered, the protocol can be unified. The present work aims to provide information on the differences in the use of regional anticoagulation with diluted or concentrated citrate. The objective is to pay special attention to aspects that can lead to complications. The unified protocol proposed in this paper could be extrapolated to any machine on the market that uses either of these two types of citrate concentration.
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Materia:	Acute renal failure (ARF) ; Circuit lifespan ; Continuous renal replacement therapy (CRRT) ; Intensive care unit (ICU) ; Ionic calcium
Publicado en:	Nursing in Critical Care, 2023 , ISSN 1478-5153

DOI: 10.1111/nicc.12991
PMID: 37897131

10 p, 1.4 MB

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