{"title":"儿科患者的区域柠檬酸抗凝：处理实践要点。","authors":"Zaccaria Ricci, Akash Deep, Stuart L Goldstein","doi":"10.1159/000548786","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Regional citrate anticoagulation (RCA) for continuous renal replacement therapy (CRRT) has been shown to be safe and effective both in adult and children. The equipment and the solutions available in the pediatric setting are the same as in adults.</p><p><strong>Summary: </strong>Currently three commercially available citrate formulations for RCA during continuous renal replacement therapy CRRT are present: concentrated (4% trisodium citrate, 136 mmol/L), semi-concentrated (anticoagulant dextrose-A, ACD-A, 75 mmol/L) and diluted (Prismocitrate/Regiocit, 18 mmol/L). RCA is delivered as a predilution infusion solution, therefore its volume in dedicated commercially available citrate solutions impacts continuous renal replacement (CRRT) dose, filtration fraction, circuit pressures and fluids flow. These aspects represent crucial details in the pediatric setting, and its relevance is more important as smaller is the patient body weight. Thus, when RCA is prescribed in children, the blood pump flow rate, the dose, the load and the concentration of citrate, and the patient's ability to metabolize citrate should be considered carefully and specifically contextualized on the citrate concentration available in each center.</p><p><strong>Conclusion: </strong>This technical review will describe these practice concepts that should be known in detail by the clinician approaching RCA in the pediatric setting.</p><p><strong>Key messages: </strong>Citrate \"dose\" is the citrate concentration in the blood running in the CRRT circuit. Citrate \"load\" represents the mass of citrate that is delivered to the circuit per each treatment hour. For a given citrate dose and blood flow rate, very different CRRT settings, sodium loads, filtration fractions, and dialytic doses are delivered by choosing the different formulations.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-7"},"PeriodicalIF":1.8000,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Regional Citrate Anticoagulation in Pediatric Patients: Dealing With Practice Points.\",\"authors\":\"Zaccaria Ricci, Akash Deep, Stuart L Goldstein\",\"doi\":\"10.1159/000548786\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Regional citrate anticoagulation (RCA) for continuous renal replacement therapy (CRRT) has been shown to be safe and effective both in adult and children. The equipment and the solutions available in the pediatric setting are the same as in adults.</p><p><strong>Summary: </strong>Currently three commercially available citrate formulations for RCA during continuous renal replacement therapy CRRT are present: concentrated (4% trisodium citrate, 136 mmol/L), semi-concentrated (anticoagulant dextrose-A, ACD-A, 75 mmol/L) and diluted (Prismocitrate/Regiocit, 18 mmol/L). RCA is delivered as a predilution infusion solution, therefore its volume in dedicated commercially available citrate solutions impacts continuous renal replacement (CRRT) dose, filtration fraction, circuit pressures and fluids flow. These aspects represent crucial details in the pediatric setting, and its relevance is more important as smaller is the patient body weight. Thus, when RCA is prescribed in children, the blood pump flow rate, the dose, the load and the concentration of citrate, and the patient's ability to metabolize citrate should be considered carefully and specifically contextualized on the citrate concentration available in each center.</p><p><strong>Conclusion: </strong>This technical review will describe these practice concepts that should be known in detail by the clinician approaching RCA in the pediatric setting.</p><p><strong>Key messages: </strong>Citrate \\\"dose\\\" is the citrate concentration in the blood running in the CRRT circuit. Citrate \\\"load\\\" represents the mass of citrate that is delivered to the circuit per each treatment hour. For a given citrate dose and blood flow rate, very different CRRT settings, sodium loads, filtration fractions, and dialytic doses are delivered by choosing the different formulations.</p>\",\"PeriodicalId\":8953,\"journal\":{\"name\":\"Blood Purification\",\"volume\":\" \",\"pages\":\"1-7\"},\"PeriodicalIF\":1.8000,\"publicationDate\":\"2025-10-03\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Blood Purification\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1159/000548786\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"HEMATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Blood Purification","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1159/000548786","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"HEMATOLOGY","Score":null,"Total":0}
Regional Citrate Anticoagulation in Pediatric Patients: Dealing With Practice Points.
Background: Regional citrate anticoagulation (RCA) for continuous renal replacement therapy (CRRT) has been shown to be safe and effective both in adult and children. The equipment and the solutions available in the pediatric setting are the same as in adults.
Summary: Currently three commercially available citrate formulations for RCA during continuous renal replacement therapy CRRT are present: concentrated (4% trisodium citrate, 136 mmol/L), semi-concentrated (anticoagulant dextrose-A, ACD-A, 75 mmol/L) and diluted (Prismocitrate/Regiocit, 18 mmol/L). RCA is delivered as a predilution infusion solution, therefore its volume in dedicated commercially available citrate solutions impacts continuous renal replacement (CRRT) dose, filtration fraction, circuit pressures and fluids flow. These aspects represent crucial details in the pediatric setting, and its relevance is more important as smaller is the patient body weight. Thus, when RCA is prescribed in children, the blood pump flow rate, the dose, the load and the concentration of citrate, and the patient's ability to metabolize citrate should be considered carefully and specifically contextualized on the citrate concentration available in each center.
Conclusion: This technical review will describe these practice concepts that should be known in detail by the clinician approaching RCA in the pediatric setting.
Key messages: Citrate "dose" is the citrate concentration in the blood running in the CRRT circuit. Citrate "load" represents the mass of citrate that is delivered to the circuit per each treatment hour. For a given citrate dose and blood flow rate, very different CRRT settings, sodium loads, filtration fractions, and dialytic doses are delivered by choosing the different formulations.
期刊介绍：
Practical information on hemodialysis, hemofiltration, peritoneal dialysis and apheresis is featured in this journal. Recognizing the critical importance of equipment and procedures, particular emphasis has been placed on reports, drawn from a wide range of fields, describing technical advances and improvements in methodology. Papers reflect the search for cost-effective solutions which increase not only patient survival but also patient comfort and disease improvement through prevention or correction of undesirable effects. Advances in vascular access and blood anticoagulation, problems associated with exposure of blood to foreign surfaces and acute-care nephrology, including continuous therapies, also receive attention. Nephrologists, internists, intensivists and hospital staff involved in dialysis, apheresis and immunoadsorption for acute and chronic solid organ failure will find this journal useful and informative. ''Blood Purification'' also serves as a platform for multidisciplinary experiences involving nephrologists, cardiologists and critical care physicians in order to expand the level of interaction between different disciplines and specialities.
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