Bioenergetic gain of citrate anticoagulated continuous hemodiafiltration--a comparison between 2 citrate modalities and unfractionated heparin
Language English Country United States Media print-electronic
Document type Comparative Study, Controlled Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't
PubMed
22951019
DOI
10.1016/j.jcrc.2012.06.003
PII: S0883-9441(12)00178-5
Knihovny.cz E-resources
- MeSH
- Acute Kidney Injury therapy MeSH
- Anticoagulants adverse effects economics pharmacology MeSH
- Citrates adverse effects economics pharmacology MeSH
- Dialysis Solutions adverse effects economics pharmacology MeSH
- Energy Metabolism drug effects MeSH
- Energy Intake drug effects MeSH
- Hemodiafiltration adverse effects economics methods MeSH
- Heparin adverse effects economics pharmacology MeSH
- Middle Aged MeSH
- Humans MeSH
- Health Care Costs MeSH
- Prospective Studies MeSH
- Water-Electrolyte Imbalance etiology prevention & control MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Controlled Clinical Trial MeSH
- Research Support, Non-U.S. Gov't MeSH
- Comparative Study MeSH
- Names of Substances
- Anticoagulants MeSH
- Citrates MeSH
- Dialysis Solutions MeSH
- Heparin MeSH
PURPOSE: To determine bioenergetic gain of 2 different citrate anticoagulated continuous hemodiafiltration (CVVHDF) modalities and a heparin modality. MATERIALS AND METHODS: We compared the bio-energetic gain of citrate, glucose and lactate between 29 patients receiving 2.2% acid-citrate-dextrose with calcium-containing lactate-buffered solutions (ACD/Ca(plus)/lactate), 34 on 4% trisodium citrate with calcium-free low-bicarbonate buffered fluids (TSC/Ca(min)/bicarbonate), and 18 on heparin with lactate buffering (Hep/lactate). RESULTS: While delivered CVVHDF dose was about 2000 mL/h, total bioenergetic gain was 262 kJ/h (IQR 230-284) with ACD/Ca(plus)/lactate, 20 kJ/h (8-25) with TSC/Ca(min)/bicarbonate (P < .01) and 60 kJ/h (52-76) with Hep/lactate. Median patient delivery of citrate was 31.2 mmol/h (25-34.7) in ACD/Ca(plus)/lactate versus 14.8 mmol/h (12.4-19.1) in TSC/Ca(min)/bicarbonate groups (P < .01). Median delivery of glucose was 36.8 mmol/h (29.9-43) in ACD/Ca(plus)/lactate, and of lactate 52.5 mmol/h (49.2-59.1) in ACD/Ca(plus)/lactate and 56.1 mmol/h (49.6-64.2) in Hep/lactate groups. The higher energy delivery with ACD/Ca(plus)/lactate was partially due to the higher blood flow used in this modality and the calcium-containing dialysate. CONCLUSIONS: The bioenergetic gain of CVVHDF comes from glucose (in ACD), lactate and citrate. The amount substantially differs between modalities despite a similar CVVHDF dose and is unacceptably high when using ACD with calcium-containing lactate-buffered solutions and a higher blood flow. When calculating nutritional needs, we should account for the energy delivered by CVVHDF.
References provided by Crossref.org
Nutrition in Critically Ill Children with AKI on Continuous RRT: Consensus Recommendations
ClinicalTrials.gov
NCT01361581
