{"title":"Regional citrate anticoagulation algorithm and management protocol aimed at ensuring blood calcium stability: a prospective single-arm study.","authors":"Ruanmei Sheng, Yimeng Liu, Shaolin Li, Jianqin Chen, Fangying Xue, Zhenjuan Dai, Ruiping Wang, Xuemin Wang","doi":"10.1093/ckj/sfaf230","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Although several regional citrate anticoagulation (RCA) algorithms have been reported, clinical data confirming their effectiveness and safety are limited. We have developed a novel RCA algorithm applicable to extensive continuous renal replacement therapy (CRRT) settings. The aims of this study were to evaluate the incidence of calcium and citrate abnormalities that necessitated human intervention when using this algorithm during RCA and to identify the optimal values of the coefficients <i>k<sub>cit</sub></i> and <i>k<sub>dis</sub></i> in the equations.</p><p><strong>Methods: </strong>We conducted a prospective, single-arm study in patients who underwent RCA using various CRRT modes and parameters, calcium-containing replacement fluids, and presession blood calcium abnormalities. The primary outcome was the incidence of citrate and calcium overdose and deficiency in the absence of human intervention. Secondary outcomes included the values of <i>k<sub>dis</sub></i> and <i>k<sub>cit</sub></i> and the occurrence of elevated or decreased blood calcium concentrations during RCA.</p><p><strong>Results: </strong>A total of 282 RCA sessions in 110 patients were investigated. The incidence of citrate and calcium abnormalities was 19.5% (55/282). In the low-dose citrate sessions, citrate overdose occurred in one session (1/148), while the incidence of citrate deficiency was 22.3% (33/148). In the high-dose citrate sessions, citrate deficiency occurred in two sessions (2/134) and citrate overdose occurred in 18/134 (13.4%) sessions. One session (1/282) of calcium overdose was also observed, whereas no calcium deficiency occurred during RCA.</p><p><strong>Conclusions: </strong>The application of this innovative RCA algorithm to sessions involving various CRRT conditions markedly decreased the incidence of citrate and calcium abnormalities. As a consequence, this reduction minimized the necessity for modifications to the rate of calcium and citrate supplementation during RCA.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 8","pages":"sfaf230"},"PeriodicalIF":4.6000,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12342615/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Kidney Journal","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1093/ckj/sfaf230","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/8/1 0:00:00","PubModel":"eCollection","JCR":"Q1","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Although several regional citrate anticoagulation (RCA) algorithms have been reported, clinical data confirming their effectiveness and safety are limited. We have developed a novel RCA algorithm applicable to extensive continuous renal replacement therapy (CRRT) settings. The aims of this study were to evaluate the incidence of calcium and citrate abnormalities that necessitated human intervention when using this algorithm during RCA and to identify the optimal values of the coefficients kcit and kdis in the equations.
Methods: We conducted a prospective, single-arm study in patients who underwent RCA using various CRRT modes and parameters, calcium-containing replacement fluids, and presession blood calcium abnormalities. The primary outcome was the incidence of citrate and calcium overdose and deficiency in the absence of human intervention. Secondary outcomes included the values of kdis and kcit and the occurrence of elevated or decreased blood calcium concentrations during RCA.
Results: A total of 282 RCA sessions in 110 patients were investigated. The incidence of citrate and calcium abnormalities was 19.5% (55/282). In the low-dose citrate sessions, citrate overdose occurred in one session (1/148), while the incidence of citrate deficiency was 22.3% (33/148). In the high-dose citrate sessions, citrate deficiency occurred in two sessions (2/134) and citrate overdose occurred in 18/134 (13.4%) sessions. One session (1/282) of calcium overdose was also observed, whereas no calcium deficiency occurred during RCA.
Conclusions: The application of this innovative RCA algorithm to sessions involving various CRRT conditions markedly decreased the incidence of citrate and calcium abnormalities. As a consequence, this reduction minimized the necessity for modifications to the rate of calcium and citrate supplementation during RCA.
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About the Journal
Clinical Kidney Journal: Clinical and Translational Nephrology (ckj), an official journal of the ERA-EDTA (European Renal Association-European Dialysis and Transplant Association), is a fully open access, online only journal publishing bimonthly. The journal is an essential educational and training resource integrating clinical, translational and educational research into clinical practice. ckj aims to contribute to a translational research culture among nephrologists and kidney pathologists that helps close the gap between basic researchers and practicing clinicians and promote sorely needed innovation in the Nephrology field. All research articles in this journal have undergone peer review.
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