Effects of Different Continuous Renal Replacement Therapy Patterns on Ionized Calcium in Patients With Citrate Anticoagulants Using Calcium-containing Replacement Solutions
Trial Parameters
Brief Summary
It is unclear whether different modes of continuous renal replacement therapy (CRRT) impact post-filter ionized calcium concentrations during regional citrate anticoagulation (RCA) when using calcium-containing replacement fluid. This prospective, single-center, observational cohort study will screen all patients receiving CRRT for eligibility. General clinical information will be collected before commencing CRRT treatment. Patients will be randomly assigned to either the veno-venous hemofiltration (CVVH) or continuous veno-venous hemodialysis (CVVHD) group and switch to the alternative mode in the subsequent treatment session. Pre-filter and post-filter ionized calcium, systemic total and ionized calcium, and effluent total and ionized calcium will be measured 2 hours after the initiation of CRRT. Electrolyte levels, arterial blood gases, hourly citrate dose, and total citrate dose will be recorded every 6 hours until the end of CRRT. The primary outcome is the difference in ionized calcium concentrations at each site over time between the two modes.
Eligibility Criteria
Inclusion Criteria: 1. Age ≥ 18 years old; 2. Receiving citrate anticoagulation; 3. Obtain Informed consent from patients or next of kin. Exclusion Criteria: 1. Pregnant or lactating women; 2. Allergic to citrate anticoagulants; 3. Severe liver dysfunction (total bilirubin levels exceeding two times the normal range); 4. Hypoxemia (PaO2 \< 60 mmHg); 5. Inadequate tissue perfusion (blood pressure \< 90/60 mmHg despite high doses of vasoactive agents); 6. Hyperlactatemia (lactate\> 4 mmol/L); 7. Hypernatremia; 8. Estimated length of hospital stay \< 48h; 9. Participated in other studies.