Regional citrate anticoagulation algorithm and management protocol aimed at ensuring blood calcium stability: a prospective single-arm study.

BACKGROUND

Although several regional citrate anticoagulation (RCA) algorithms have been reported, clinical data confirming their effectiveness and safety are limited. We have developed a novel RCA algorithm applicable to extensive continuous renal replacement therapy (CRRT) settings. The aims of this study were to evaluate the incidence of calcium and citrate abnormalities that necessitated human intervention when using this algorithm during RCA and to identify the optimal values of the coefficients kcit and kdis in the equations.

METHODS

We conducted a prospective, single-arm study in patients who underwent RCA using various CRRT modes and parameters, calcium-containing replacement fluids, and presession blood calcium abnormalities. The primary outcome was the incidence of citrate and calcium overdose and deficiency in the absence of human intervention. Secondary outcomes included the values of kdis and kcit and the occurrence of elevated or decreased blood calcium concentrations during RCA.

RESULTS

A total of 282 RCA sessions in 110 patients were investigated. The incidence of citrate and calcium abnormalities was 19.5% (55/282). In the low-dose citrate sessions, citrate overdose occurred in one session (1/148), while the incidence of citrate deficiency was 22.3% (33/148). In the high-dose citrate sessions, citrate deficiency occurred in two sessions (2/134) and citrate overdose occurred in 18/134 (13.4%) sessions. One session (1/282) of calcium overdose was also observed, whereas no calcium deficiency occurred during RCA.

CONCLUSIONS

The application of this innovative RCA algorithm to sessions involving various CRRT conditions markedly decreased the incidence of citrate and calcium abnormalities. As a consequence, this reduction minimized the necessity for modifications to the rate of calcium and citrate supplementation during RCA.