No Monitoring of Post-filter Ionized Calcium in Regional Citrate Anticoagulation

Chulalongkorn University50 enrolled

Overview

Do no monitor of post-circuit ionized calcium affact the filter life time of continueous renal replacement therapy with regional citrate anticoagulation circuit? A randomized control trial

Regional citrate anticoagulation is the gold standard of anticoagulation in patient receiving CRRT. In RCA circuit, there was a monitoring of pre-filter (systemic) ionized calcium and post-filter (circuit) ionized calcium. Pre-filter ionized calcium was monitored for observe the adverse effect of citrate such as hypocalcemia, citrate intoxication. However, post-filter ionized calcium was monitored for adjustment the citrate dose. We find many problem with frequently monitoring of post-ionized calcium such as confusion from markedly abnormal result, how to adjustment the citrate dose ,and increase workload for nurses. We hypothesis that if we can monitoring of post-filter ionized calcium?

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Enrollment

Conditions

Regional Citrate Anticoagulation Ionized Calcium Continuous Renal Replacement Therapy

Interventions

Regional citrate anticoagulationOTHER

Starting RCA 4 mmol/L (adjust the rate by BFR)

VasopressorDRUG

Vasopressors such as Norepinephrine, dopamine, milrinone, dobutamine

AntibioticDRUG

Antibacterial agents deemed appropriate by physicians in the ICU

Eligibility

Sex: ALLMin age: 18 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * Age older than 18 years old and admission in an ICU * Indication for CRRT * regional citrate anticoagulation Exclusion Criteria: * Acute liver failure defined as AST or ALT \> 5X UNL or TB/DB \> 5X UNL or evidence of cirrhosis * Severe persistent lactic acidosis (lactate persist \> 8 mg/dL consecutively within 6 hours) * Receiving heparin anticoagulation * Severe alkalosis (pH\>7.55) or acidosis (pH\<7.1) * History of renal allograft * Known pregnancy * Patient is moribund with expected death within 24 hr * Deficiency of ionzed calcium (Cation \< 0.8 mmol/L)

Locations (1)

Chulalongkorn university

Bangkok, Thailand

Outcomes

Primary Outcomes

Filter lifetime in hours

How long with filter with RCA

Time frame: 72 hours

Secondary Outcomes

Adverse event

adverse event of RCA

Time frame: 72 hours

Circuit downtime in hours

Circuit downtime during CRRT with RCA

Time frame: 72 hours

Cost per treatment in Baht

Cost of CRRT include laboratory in Baht

Time frame: 72 hour

Citrate accumulation

Number of total calcium to ionized calcium ratio \> 2.5

Time frame: 72 hours

Efficacy of CRRT

Seiving coefficient of urea and difference of prescribed dose of CRRT

Time frame: 72 hours

Citrate dose

Average citrate dose

Time frame: 72 hours

Data from ClinicalTrials.gov

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