Continuous venovenous hemofiltration with or without predilution regional citrate anticoagulation: a prospective study

S Azam Nurmohamed, Marc G Vervloet, Armand R J Girbes, Pieter M Ter Wee, A B Johan Groeneveld

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

BACKGROUND/AIMS: Continuous venovenous hemofiltration (CVVH) requires anticoagulation to prevent circuit clotting and its use is contraindicated in patients with high bleeding risk. The aim of this study was to compare CVVH with and without regional citrate anticoagulation (RCA) with respect to filter life, azotemic control and cost.

METHODS: This was a prospective sequential cohort study. The first cohort of patients with a high bleeding risk and acute renal failure was treated by anticoagulant-free predilution CVVH (n = 31). In the second cohort, CVVH was applied with RCA (n = 20).

RESULTS: The median filter life was 41 h (interquartile range 20-62) with RCA and 12 h (8-28) without RCA (p = 0.001). The azotemic control was better in the group with RCA. The hourly cost was comparable between the two groups.

CONCLUSION: Regional anticoagulation with citrate-based replacement solution improved filter life compared to anticoagulant-free predilution CVVH. This regimen appeared safe, feasible and without metabolic complications or increased costs.

Original languageEnglish
Pages (from-to)316-23
Number of pages8
JournalBlood Purification
Volume25
Issue number4
DOIs
Publication statusPublished - 2007

Cite this

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title = "Continuous venovenous hemofiltration with or without predilution regional citrate anticoagulation: a prospective study",
abstract = "BACKGROUND/AIMS: Continuous venovenous hemofiltration (CVVH) requires anticoagulation to prevent circuit clotting and its use is contraindicated in patients with high bleeding risk. The aim of this study was to compare CVVH with and without regional citrate anticoagulation (RCA) with respect to filter life, azotemic control and cost.METHODS: This was a prospective sequential cohort study. The first cohort of patients with a high bleeding risk and acute renal failure was treated by anticoagulant-free predilution CVVH (n = 31). In the second cohort, CVVH was applied with RCA (n = 20).RESULTS: The median filter life was 41 h (interquartile range 20-62) with RCA and 12 h (8-28) without RCA (p = 0.001). The azotemic control was better in the group with RCA. The hourly cost was comparable between the two groups.CONCLUSION: Regional anticoagulation with citrate-based replacement solution improved filter life compared to anticoagulant-free predilution CVVH. This regimen appeared safe, feasible and without metabolic complications or increased costs.",
keywords = "Acute Kidney Injury/complications, Aged, Anticoagulants/administration & dosage, Calcium/administration & dosage, Citrates/administration & dosage, Cohort Studies, Critical Care/methods, Equipment Failure, Female, Hemofiltration/methods, Hemorrhage/chemically induced, Hemorrhagic Disorders/complications, Humans, Male, Middle Aged, Prospective Studies, Solutions",
author = "Nurmohamed, {S Azam} and Vervloet, {Marc G} and Girbes, {Armand R J} and {Ter Wee}, {Pieter M} and Groeneveld, {A B Johan}",
note = "Copyright 2007 S. Karger AG, Basel.",
year = "2007",
doi = "10.1159/000107045",
language = "English",
volume = "25",
pages = "316--23",
journal = "Blood Purification",
issn = "0253-5068",
publisher = "S. Karger AG",
number = "4",

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Continuous venovenous hemofiltration with or without predilution regional citrate anticoagulation : a prospective study. / Nurmohamed, S Azam; Vervloet, Marc G; Girbes, Armand R J; Ter Wee, Pieter M; Groeneveld, A B Johan.

In: Blood Purification, Vol. 25, No. 4, 2007, p. 316-23.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Continuous venovenous hemofiltration with or without predilution regional citrate anticoagulation

T2 - a prospective study

AU - Nurmohamed, S Azam

AU - Vervloet, Marc G

AU - Girbes, Armand R J

AU - Ter Wee, Pieter M

AU - Groeneveld, A B Johan

N1 - Copyright 2007 S. Karger AG, Basel.

PY - 2007

Y1 - 2007

N2 - BACKGROUND/AIMS: Continuous venovenous hemofiltration (CVVH) requires anticoagulation to prevent circuit clotting and its use is contraindicated in patients with high bleeding risk. The aim of this study was to compare CVVH with and without regional citrate anticoagulation (RCA) with respect to filter life, azotemic control and cost.METHODS: This was a prospective sequential cohort study. The first cohort of patients with a high bleeding risk and acute renal failure was treated by anticoagulant-free predilution CVVH (n = 31). In the second cohort, CVVH was applied with RCA (n = 20).RESULTS: The median filter life was 41 h (interquartile range 20-62) with RCA and 12 h (8-28) without RCA (p = 0.001). The azotemic control was better in the group with RCA. The hourly cost was comparable between the two groups.CONCLUSION: Regional anticoagulation with citrate-based replacement solution improved filter life compared to anticoagulant-free predilution CVVH. This regimen appeared safe, feasible and without metabolic complications or increased costs.

AB - BACKGROUND/AIMS: Continuous venovenous hemofiltration (CVVH) requires anticoagulation to prevent circuit clotting and its use is contraindicated in patients with high bleeding risk. The aim of this study was to compare CVVH with and without regional citrate anticoagulation (RCA) with respect to filter life, azotemic control and cost.METHODS: This was a prospective sequential cohort study. The first cohort of patients with a high bleeding risk and acute renal failure was treated by anticoagulant-free predilution CVVH (n = 31). In the second cohort, CVVH was applied with RCA (n = 20).RESULTS: The median filter life was 41 h (interquartile range 20-62) with RCA and 12 h (8-28) without RCA (p = 0.001). The azotemic control was better in the group with RCA. The hourly cost was comparable between the two groups.CONCLUSION: Regional anticoagulation with citrate-based replacement solution improved filter life compared to anticoagulant-free predilution CVVH. This regimen appeared safe, feasible and without metabolic complications or increased costs.

KW - Acute Kidney Injury/complications

KW - Aged

KW - Anticoagulants/administration & dosage

KW - Calcium/administration & dosage

KW - Citrates/administration & dosage

KW - Cohort Studies

KW - Critical Care/methods

KW - Equipment Failure

KW - Female

KW - Hemofiltration/methods

KW - Hemorrhage/chemically induced

KW - Hemorrhagic Disorders/complications

KW - Humans

KW - Male

KW - Middle Aged

KW - Prospective Studies

KW - Solutions

U2 - 10.1159/000107045

DO - 10.1159/000107045

M3 - Article

VL - 25

SP - 316

EP - 323

JO - Blood Purification

JF - Blood Purification

SN - 0253-5068

IS - 4

ER -