Abstract: FR-PO130
Calcium Balance in Slow Extended Dialysis: Effect of Regional Citrate vs. Other Anticoagulation Strategies in a Randomized Trial
Session Information
- AKI: Outcomes, RRT
November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Mota, Lucas Braga, Heart Institute, São Paulo, São Paulo, SP, Brazil
- Macedo, Etienne, University of California San Diego Department of Medicine, La Jolla, California, United States
- Moyses, Rosa M.A., University of São Paulo Medical School, São Paulo, São Paulo, Brazil
- Costa, Maristela Carvalho, Heart Institute, São Paulo, São Paulo, SP, Brazil
- Battaini, Ligia Costa, Heart Institute, São Paulo, São Paulo, SP, Brazil
- Galas, Filomena Regina, Heart Institute, São Paulo, São Paulo, SP, Brazil
- Nicolau, Jose, Heart Institute, São Paulo, São Paulo, SP, Brazil
- Lage, Silvia G., Heart Institute, São Paulo, São Paulo, SP, Brazil
- Zanetta, Dirce M T, University of São Paulo Medical School, São Paulo, São Paulo, Brazil
- Burdmann, Emmanuel A., University of São Paulo Medical School, São Paulo, São Paulo, Brazil
- Costa e Silva, Veronica Torres, University of São Paulo Medical School, São Paulo, São Paulo, Brazil
Background
Regional citrate anticoagulation (RCA) has been used as an alternative to heparin during slow extended dialysis (SLED) in patients with acute kidney injury (AKI). However, there is scanty data on the impact of different anticoagulation strategies on calcium balance during these procedures. This study aimed to determine calcium balance in SLED using RCA compared to saline or heparin in a crossover randomized clinical trial (RCT).
Methods
We included 20 critically ill adults with AKI who were eligible to SLED (6 to 8 hours) in a tertiary center in Brazil. They were randomized to either RCA or standard of care (heparin as the first choice or continuous saline flush, in case of heparin contraindication) in a crossover manner. Dialysis was carried out using single-pass batch equipment, until the maximum of six therapies per subject. RCA used ACD 2.2% at 3mmol/L (320mL/h), post filter calcium target 0.6 - 0.7mmol/L, and pre-filter calcium target 1.10 - 1.32mmol/L. Dialysate calcium was 1.25 mmol/L in all therapies. The primary outcome was calcium balance.
Results
In 48 procedures, 24 used citrate, and 24 used heparin or continuous saline. Each participant performed 2 (1 - 3) sessions in the protocol. Patients age was 66 (40 - 71) years, 55% men, 15% on mechanical ventilation, and 20% using vasoactive agents. All groups had a negative calcium balance, markedly in dialysis using RCA.
Conclusion
In this RCT, SLED was associated with negative calcium balance independently of the anticoagulation strategy, although calcium loss was more prominent in the RCA group. Further studies are needed to corroborate our results and investigate the determinants of calcium loss during SLED.
Dialysis parameters (n = 48)
| CITRATE (24) | HEPARIN (14) | SALINE (10) | |
| Blood / dialysate flow (mL/min) | 180 (180 - 180) | 180 (180 - 180) | 180 (180 - 180) |
| Time (min) | 420 (397 - 470) | 390 (360 - 480) | 420 (366 - 420) |
| UF (L) | 2.0 (1.9 - 2.4) | 2.1 (1.9 - 2.5) | 2.0 (1.3 - 2.1) |
| Total volume removed (L) | 4.9 (4.5 - 5.3) | 2.5 (2.3 - 2.9) | 3.4 (2.8 - 3.7) |
| Calcium balance (mg) ** | -625 (-373 to -740) | -527 (-253 to -678) | -422 (-168 to -609) |
*Calcium balance, difference between given calcium in infusion pump and dialysate and the estimated calcium lost in effluent and ultrafiltration (UF)
Funding
- Government Support – Non-U.S.