Ottimizzazione di un protocollo di anticoagulazione regionale con citrato in CRRT

Optimization of a regional citrate anticoagulation protocol in CRRT Purpose: Prolonged anticoagulation and hypophosphatemia are well known drawbacks of CRRT. The aim of our study was to show the efficacy and safety of a regional citrate anticoagulation protocol for CVVH combined with a phosphate containing replacement fluid. Methods: We used our protocol, based on a citrate solution (18 mmol/l) combined with in a phosphate containing replacement fluid, in a small cohort of heart surgery patients. Results: Our protocol provided an adequate circuit lifetime and an excellent acid-base status in every patient. A low amount of phosphorus supplememntation was required only in a very few patients. Conclusions: Our protocol based on a citrate solution (18 mmol/l) combined with a phosphate containing replacement fluid, allows a better buffer balance control than using of a lower citrate solution. Moreover, an adequate circuit lifetime was obtained. Serum phosphate was steadily maintained in all patients. Only in a very few patients a low supplementation was required.