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  • Open Access

Impact of continuous veno-venous hemodiafiltration with regional citrate anticoagulation on the acid-base balance of critically ill patients

  • 1,
  • 1,
  • 1,
  • 1,
  • 1,
  • 1,
  • 1,
  • 1 and
  • 1
Critical Care200610 (Suppl 1) :P282

https://doi.org/10.1186/cc4629

  • Published:

Keywords

  • Acute Renal Failure
  • Metabolic Acidosis
  • Calcium Ratio
  • Chloride Level
  • Regional Citrate Anticoagulation

Background

Continuous veno-venous hemodiafiltration (CVVHDF) with regional citrate anticoagulation (RCA) has been applied to the treatment of critically ill acute renal failure (ARF) patients for years. It has a substantial effect on acid-base homeostasis. Accordingly, we investigated a cohort of patients requiring CVVHDF and assessed their acid-base changes by quantitative biophysical principles (Stewart-Figge approach).

Methods

We studied 32 consecutive critical care ARF patients on CVVHDF with RCA. All relevant variables for acid-base analysis were measured according to the Stewart-Figge methodology.

Results

Before CVVHDF treatment, the patients had metabolic acidosis with mild increase of the anion gap. The excess of unmeasured anions was the most important component of acidosis. Median lactate, phosphate and chloride levels were in the normal range. The median albumin was 2.3 mg/dl and had an alkalinizing effect.

On the third CVVHDF day, the median pH, bicarbonate, anion gap, BE and SIG had significantly decreased. The median value of the total calcium-ionic calcium ratio, a surrogate marker of citrate accumulation, did not change significantly over treatment, and was maintained below 2.5 mg/dl.

Conclusion

In critically ill ARF patients, CVVHDF with RCA is a safe RRT modality and it corrected metabolic acidosis through its effects on unmeasured anions.

Table 1

 

Pre

25th/75th

D1

25th/75th

D2

25th/75th

D3

25th/75th

Friedman

pH

7.35

7.25/7.41

7.37

7.33/7.4

7.42

7.38/7.45

7.42

7.38/7.46

P < 0.0001

pCO2

34.9

30.7/42.6

37.9

33.9/42.3

38.7

34.3/42.9

38

34.5/41.5

P = 0.3773

HCO3

19.3

17.3/21

21.6

19.5/23.5

24.6

21.6/25.9

25.5

21.4/26.6

P < 0.0001

BE

-5.9

-8.7/-3.3

-2.9

-5.1/-1.3

0.2

-3.2/2.3

0.8

-2.6/2.6

P < 0.001

SIDa

40

36/43.6

39.1

36.2/40.8

39

36.6/40.5

39.2

36.5/41.8

P = 0.9189

SIDe

29.1

26.4/30.7

31

28.2/33

33

31.2/34.6

33.6

32/36

P < 0.0001

SIG

10.4

7.2/14.5

7.21

5.8/10.8

5.5

3.7/7.2

5.1

4/7

P < 0.001

AG

17.6

15.7/22.8

16.6

14.5/18.5

13.8

11.7/16

14.1

13/15.7

P < 0.0001

A-

8.6

7.7/10.5

8.9

8.8/10.5

8.6

7.8/10.6

8.7

7.9/10.3

P = 0.7704

Authors’ Affiliations

(1)
Hospital Israelita Albert Einstein, Sao Paulo, Brazil

Copyright

© BioMed Central Ltd 2006

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