Kidney Week

Abstract: SA-PO043

Anticoagulation in Extended Kidney Replacement Therapy (EKRT) for Critically Ill Patients with AKI: Efficacy and Safety of Citrate vs. Saline

Session Information

• AKI: Clinical, Outcomes, and Trials - Management
  October 26, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

• 102 AKI: Clinical, Outcomes, and Trials

Authors

• Mota, Lucas Braga, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, São Paulo, Brazil

Lucas Braga Mota, MD

• Macedo, Etienne, University of California San Diego, La Jolla, California, United States

Etienne Macedo, MD, PhD, FASN

• Caires, Renato A., Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, São Paulo, Brazil

Renato A. Caires, MD

• Battaini, Ligia Costa, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, São Paulo, Brazil

Ligia Costa Battaini, MD

• Costalonga, Elerson, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, São Paulo, Brazil

Elerson Costalonga, MD, PhD

• Costa, Maristela Carvalho, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, São Paulo, Brazil

Maristela Carvalho Costa, MD, PhD

• Burdmann, Emmanuel A., Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, São Paulo, Brazil

Emmanuel A. Burdmann, MD, PhD

• Costa e Silva, Veronica Torres, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, São Paulo, Brazil

Veronica Torres Costa e Silva, MD

Background

Regional citrate anticoagulation (RCA) is becoming a popular alternative to heparin for EKRT in acute kidney injury (AKI) patients in the intensive care unit (ICU). Single-pass batch dialysis (SBD) is well suited for EKRT, yet there is limited data with RCA. This study compares efficacy and safety of RCA vs. saline for SBD-EKRT in ICU patients with AKI.

Methods

We conducted a prospective cohort using SBD-EKRT in critically ill adults with AKI from January 2015 through February 2020 at a tertiary university hospital in Brazil. Patients were divided in two groups, RCA and normal saline (NS). RCA used either citrate 4% or acid citrate dextrose (ACD) 2.2%, initial dose of 3 mmol/L. Calcium levels were measured every 2 hours for adjustment. The saline infusion rate (mL/h) matched the blood flow (mL/min). The primary outcome was filter clotting.

Results

The RCA group included 25 patients, and 39 EKRT sessions, while the NS group included 17 patients, and 31 EKRT sessions.
All 42 patients were 63y (47-67), 59% male, main AKI cause was sepsis (60%), 20% on vasopressors, and 7% on mechanical ventilation.
RCA had longer therapies, lower median blood flow, and higher ultrafiltration (UF) targets, compared to NS. Clotting interruption occurred in 3 (7.9%) RCA sessions and in 5 (16.1%) NS therapies (p=0.28). Hypotension (mean blood pressure <65 mmHg) frequency was similar (p=0.60) in both groups. A good metabolic control was achieved by RCA-SBD, post KRT laboratory disclosed creatinine 2.19 mg/dL (1.6-3.0), urea 55 mg/dL (29-105), potassium 3.9 mEq/L (3.5-4.2), and ionized calcium 4.1 mg/dL (3.9-4.4). During RCA-SPB, frequency of severe hypocalcemia (≤ 4 mg/dL) and bicarbonate ≥ 29 mEq/L were 35% and 8%, respectively.

Conclusion

This is the largest series of ICU patients with AKI with RCA in SBD-EKRT, showing safety and efficacy.

Table 1 - KRT data

Results in number (%), or median (25-75 IQR)

Funding

• Government Support – Non-U.S.