P1074SIMPLIED REGIONAL CITRATE ANTICOULATION USING A CALCIUM-CONTAINING REPLACEMENT SOLUTION FOR RENAL REPLACEMENT THERAPY: A RANDOMIZED CONTROLLED CLINICAL TRIAL

Abstract

Abstract Background and Aims A simplified protocol for Regional citrate anticoagulation (RCA) using a commercial calcium-containing replacement solution, without a continuous calcium infusion, is more efficient to be used in continuous renal replacement therapy (CRRT). We aim to design a randomized prospective pilot trial to compare the safety and efficacy between calcium-free and calcium-containing replacement solution in CRRT with RCA. Method Of the 59 patients who requiring CRRT and being treated with RCA-based continuous venovenous hemodiafiltration (CVVHDF) enrolled, 31 patients were randomized to calcium-containing group and 28 to calcium-free replacement solution group. Primary endpoints were filters lifespan. Secondary endpoints were mortality, kidney function recovery and severe complications rates. Time spent on fluids preparation before CRRT and the amount of 4% trisodium citrate solution pumped during CRRT were recorded. Serum and effluent citrate and calcium concentration during CVVHDF were measured during CRRT. Results Filters lifespan were superior for calcium-containing group (mean 58.06 versus 47.12 hours, P=0.05). Mortality and renal outcome were comparable between groups during hospitalization: 10/31 (33.26%) of calcium-containing group patients died versus 13/28 (46.43%) of calcium-free group patients, and 16/31 (51.61%) of calcium-containing group patients had kidney function recovery versus 15/28 (53.57%) of calcium-containing group (P = 0.265). Only 5 patients showed the symptoms and signs of hypocalcemia or citrate toxicity in this study. The mean CRRT preparation time in calcium-containing group: 25.5 minutes, was significantly shorter than calcium-free group: 43.7 minutes (p<0.001). The serum and effluent calcium concentration was slightly lower in calcium-containing group during CRRT. While, the mean 4% trisodium citrate solution infusion rate was similar between groups (161.5 mL/h versus 157.4 mL/h, P=0.376). Conclusion Patients treated with calcium-containing or calcium-free replacement solution have similar clinical outcomes. Since the calcium-containing replacement solution based RCA has longer filter lifespan and obviates the need for a separate venous catheter and intravenous calcium preparation for continuous intravenous calcium infusion, it is more efficient to be used in clinical practice and superior to the calcium-free replacement solution.