Bioenergetic gain of citrate anticoagulated continuous hemodiafiltration¡ªa comparison between 2 citrate modalities and unfractionated heparin

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• 作者：Martin Balik ; MD ; PhD^a ; ^{martin.balik@post.cz} ; Mykhaylo Zakharchenko ; MD^a ; Pavel Leden ; MD^a ; Michal Otahal ; MD^a ; Jan Hruby ; MD^a ; Ferdinand Polak ; MD ; PhD^a ; Katerina Rusinova ; MD^a ; Zdenek Stach ; MD^a ; Monika Tokarik ; MD^b ; Jaroslava Vavrova ; PhD^c ; Antonin Jabor ; MD ; PhD^d ; Heleen M. Oudemans-van Straaten ; MD ; PhD^e
• 关键词：Acute renal failure ; Anticoagulation ; Citrate ; Hemodiafiltration ; Renal replacement therapy
• 刊名：Journal of Critical Care
• 出版年：2013
• 出版时间：February, 2013
• 年：2013
• 卷：28
• 期：1
• 页码：87-95
• 全文大小：282 K

文摘

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 262kJ/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.