Kidney Week

Abstract: TH-PO228

Extracorporeal Carbon Dioxide Removal Instead of Mechanical Ventilation in a Patient with Respiratory Distress and Acute Kidney Failure, with Active Bleeding Using Regional Anticoagulation

Session Information

• Hemodialysis, Hemodiafiltration, and Frequent Dialysis
  October 24, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Kalil, Milton, Hospital Moinhos de Vento, Porto Alegre, RS, Brazil

Milton Kalil, MD

• Eick, Renato Eorgeg, Hospital Moinhos de Vento, Porto Alegre, RS, Brazil

Renato Eorgeg Eick, MD

• Saitovich, David, Hospital Moinhos de Vento, Porto Alegre, RS, Brazil

David Saitovich

• Stein, Anna Cristina, Hospital Moinhos de Vento, Porto Alegre, RS, Brazil

Anna Cristina Stein, PhD

• Da Luz, Lucas G., Hospital Moinhos de Vento, Porto Alegre, RS, Brazil

Lucas G. Da Luz, MD

• Balestrin, Illan George, Hospital Moinhos de Vento, Porto Alegre, RS, Brazil

Illan George Balestrin, MD

• Gazzana, Marcelo Basso, Hospital Moinhos de Vento, Porto Alegre, RS, Brazil

Marcelo Basso Gazzana, MD, MSc, PhD

• André, Mauricio Lutzky, Hospital Moinhos de Vento, Porto Alegre, RS, Brazil

Mauricio Lutzky André

Introduction

There are only a few reports so far describing the use of citrate (regional) anticoagulation for CO2 removal (ECCO2R) probably due to the
metabolic complications and electrolyte disturbances that occur with the high blood flow rate (for efficient CO2 removal) and higher than usual citrate flow rate, necessary for the procedure.

Case Description

Citrate anticoagulation in continuous venovenous hemodiafiltration (CVVHDF) associated with extracorporeal carbon dioxide removal (ECCO2R) was performed in a 71 years old patient with active bleeding and severe respiratory acidosis for 5 days. This procedure was carried out with a Fresenius (multiECCO2R), a single gas exchanger combined with continuous kidney replacement therapy (CKRT). Dialysis prescription was blood flow rate of 300ml/min, sodium citrate 4% infusion rate of 300ml/h, calcium chloride 3.38% replacement solution rate of 30ml/h, and oxygen flow rate of 4.5L/min. Dialysis and replacement solutions bicarbonate and sodium concentration were respectively 10mEq/L and 129mEq/L.The patient remained without endotracheal intubation during the procedure period. A reduction of approximately 30% pCO2 was attained, respiratory acidosis was controlled and the hydroelectrolytic balance was maintained(Table1).

Discussion

In cases of CO2 removal in the context of regional anticoagulation with citrate, it is important to adjust calcium replacement according to effluent volume and also to adjust bicarbonate and sodium concentrations in dialysis solutions. We conclude that it is possible and safe to remove CO2 in a CVVHDF + multi ECCO2R single system, using sodium citrate for regional anticoagulation.