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01-08-2007 | Review

Clinical review: Patency of the circuit in continuous renal replacement therapy

Authors: Michael Joannidis, Heleen M Oudemans-van Straaten

Published in: Critical Care | Issue 4/2007

Abstract

Premature circuit clotting is a major problem in daily practice of continuous renal replacement therapy (CRRT), increasing blood loss, workload, and costs. Early clotting is related to bioincompatibility, critical illness, vascular access, CRRT circuit, and modality. This review discusses non-anticoagulant and anticoagulant measures to prevent circuit failure. These measures include optimization of the catheter (inner diameter, pattern of flow, and position), the settings of CRRT (partial predilution and individualized control of filtration fraction), and the training of nurses. In addition, anticoagulation is generally required. Systemic anticoagulation interferes with plasmatic coagulation, platelet activation, or both and should be kept at a low dose to mitigate bleeding complications. Regional anticoagulation with citrate emerges as the most promising method.

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Levi M, Opal SM: Coagulation abnormalities in critically ill patients. Crit Care. 2006, 10: 222-10.1186/cc4975.PubMedCentralCrossRefPubMed

Cardigan RA, McGloin H, Mackie IJ, Machin SJ, Singer M: Activation of the tissue factor pathway occurs during continuous venovenous hemofiltration. Kidney Int. 1999, 55: 1568-1574. 10.1046/j.1523-1755.1999.00397.x.CrossRefPubMed

Salmon J, Cardigan R, Mackie I, Cohen SL, Machin S, Singer M: Continuous venovenous haemofiltration using polyacrylonitrile filters does not activate contact system and intrinsic coagulation pathways. Intensive Care Med. 1997, 23: 38-43. 10.1007/s001340050288.CrossRefPubMed

Bouman CS, de Pont AC, Meijers JC, Bakhtiari K, Roem D, Zeerleder S, Wolbink G, Korevaar JC, Levi M, de Jonge E: The effects of continuous venovenous hemofiltration on coagulation activation. Crit Care. 2006, 10: R150-10.1186/cc5080.PubMedCentralCrossRefPubMed

Baldwin I, Bellomo R, Koch B: Blood flow reductions during continuous renal replacement therapy and circuit life. Intensive Care Med. 2004, 30: 2074-2079. 10.1007/s00134-004-2440-0.CrossRefPubMed

Holt AW, Bierer P, Bersten AD, Bury LK, Vedig AE: Continuous renal replacement therapy in critically ill patients: monitoring circuit function. Anaesth Intensive Care. 1996, 24: 423-429.PubMed

de Pont AC, Oudemans-van Straaten HM, Roozendaal KJ, Zandstra DF: Nadroparin versus dalteparin anticoagulation in high-volume, continuous venovenous hemofiltration: a double-blind, randomized, crossover study. Crit Care Med. 2000, 28: 421-425. 10.1097/00003246-200002000-00022.CrossRefPubMed

Cutts MW, Thomas AN, Kishen R: Transfusion requirements during continuous veno-venous haemofiltration: the importance of filter life. Intensive Care Med. 2000, 26: 1694-1697. 10.1007/s001340000676.CrossRefPubMed

Oudemans-van Straaten HM, Wester JP, de Pont AC, Schetz MR: Anticoagulation strategies in continuous renal replacement therapy: can the choice be evidence based?. Intensive Care Med. 2006, 32: 188-202. 10.1007/s00134-005-0044-y.CrossRefPubMed

10.

Unger JK, Haltern C, Portz B, Dohmen B, Gressner A, Rossaint R: Relation of haemofilter type to venous catheter resistance is crucial for filtration performance and haemocompatibility in CVVH – an in vitro study. Nephrol Dial Transplant. 2006, 21: 2191-2201. 10.1093/ndt/gfl068.CrossRefPubMed

11.

Canaud B, Desmeules S, Klouche K, Leray-Moragues H, Beraud JJ: Vascular access for dialysis in the intensive care unit. Best Pract Res Clin Anaesthesiol. 2004, 18: 159-174. 10.1016/j.bpa.2003.09.010.CrossRefPubMed

12.

Jean G, Chazot C, Vanel T, Charra B, Terrat JC, Calemard E, Laurent G: Central venous catheters for haemodialysis: looking for optimal blood flow. Nephrol Dial Transplant. 1997, 12: 1689-1691. 10.1093/ndt/12.8.1689.CrossRefPubMed

13.

Mandolfo S, Borlandelli S, Ravani P, Imbasciati E: How to improve dialysis adequacy in patients with vascular access problems. J Vasc Access. 2006, 7: 53-59.PubMed

14.

Hernández D, Díaz F, Rufino M, Lorenzo V, Pérez T, Rodríguez A, De Bonis E, Losada M, González-Posada JM, Torres A: Subclavian vascular access stenosis in dialysis patients: natural history and risk factors. J Am Soc Nephrol. 1998, 9: 1507-1510.PubMed

15.

Agraharkar M, Isaacson S, Mendelssohn D, Muralidharan J, Mustata S, Zevallos G, Besley M, Uldall R: Percutaneously inserted silastic jugular hemodialysis catheters seldom cause jugular vein thrombosis. ASAIO J. 1995, 41: 169-172.CrossRefPubMed

16.

Oliver MJ: Acute dialysis catheters. Semin Dial. 2001, 14: 432-435. 10.1046/j.1525-139x.2001.00107.x.CrossRefPubMed

17.

Karakitsos D, Labropoulos N, De Groot E, Patrianakos AP, Kouraklis G, Poularas J, Samonis G, Tsoutsos DA, Konstadoulakis MM, Karabinis A: Real-time ultrasound-guided catheterisation of the internal jugular vein: a prospective comparison with the landmark technique in critical care patients. Crit Care. 2006, 10: R162-10.1186/cc5101.PubMedCentralCrossRefPubMed

18.

Weijmer MC, van den Dorpel MA, Van de Ven PJ, ter Wee PM, van Geelen JA, Groeneveld JO, van Jaarsveld BC, Koopmans MG, le Poole CY, Schrander-Van der Meer AM, CITRATE Study Group, et al: Randomized, clinical trial comparison of trisodium citrate 30% and heparin as catheter-locking solution in hemodialysis patients. J Am Soc Nephrol. 2005, 16: 2769-2777. 10.1681/ASN.2004100870.CrossRefPubMed

19.

Grudzinski L, Quinan P, Kwok S, Pierratos A: Sodium citrate 4% locking solution for central venous dialysis catheters – an effective, more cost-efficient alternative to heparin. Nephrol Dial Transplant. 2007, 22: 471-476. 10.1093/ndt/gfl606.CrossRefPubMed

20.

Davies H, Leslie G: Maintaining the CRRT circuit: non-anticoagulant alternatives. Aust Crit Care. 2006, 19: 133-138. 10.1016/S1036-7314(06)80026-3.CrossRefPubMed

21.

Schetz M: Anticoagulation in continuous renal replacement therapy. Contrib Nephrol. 2001, 283-303. 132

22.

Ramesh Prasad GV, Palevsky PM, Burr R, Lesko JM, Gupta B, Greenberg A: Factors affecting system clotting in continuous renal replacement therapy: results of a randomized, controlled trial. Clin Nephrol. 2000, 53: 55-60.PubMed

23.

Ricci Z, Ronco C, Bachetoni A, D'amico G, Rossi S, Alessandri E, Rocco M, Pietropaoli P: Solute removal during continuous renal replacement therapy in critically ill patients: convection versus diffusion. Crit Care. 2006, 10: R67-10.1186/cc4903.PubMedCentralCrossRefPubMed

24.

Brophy PD, Somers MJ, Baum MA, Symons JM, McAfee N, Fortenberry JD, Rogers K, Barnett J, Blowey D, Baker C, et al: Multi-centre evaluation of anticoagulation in patients receiving continuous renal replacement therapy (CRRT). Nephrol Dial Transplant. 2005, 20: 1416-1421. 10.1093/ndt/gfh817.CrossRefPubMed

25.

Uchino S, Fealy N, Baldwin I, Morimatsu H, Bellomo R: Pre-dilution vs. post-dilution during continuous veno-venous hemofiltration: impact on filter life and azotemic control. Nephron Clin Pract. 2003, 94: c94-c98. 10.1159/000072492.CrossRefPubMed

26.

Van der Voort PH, Gerritsen RT, Kuiper MA, Egbers PH, Kingma WP, Boerma EC: Filter run time in CVVH: pre-versus post-dilution and nadroparin versus regional heparin-protamine anticoagulation. Blood Purif. 2005, 23: 175-180. 10.1159/000083938.CrossRefPubMed

27.

Clark WR, Gao D: Low-molecular weight proteins in end-stage renal disease: potential toxicity and dialytic removal mechanisms. J Am Soc Nephrol. 2002, 13 (Suppl 1): S41-S47.PubMed

28.

Padrini R, Canova C, Conz P, Mancini E, Rizzioli E, Santoro A: Convective and adsorptive removal of beta2-microglobulin during predilutional and postdilutional hemofiltration. Kidney Int. 2005, 68: 2331-2337. 10.1111/j.1523-1755.2005.00694.x.CrossRefPubMed

29.

Zhu LP, Zhang XX, Xu L, Du CH, Zhu BK, Xu YY: Improved protein-adsorption resistance of polyethersulfone membranes via surface segregation of ultrahigh molecular weight poly(styrene-alt-maleic anhydride). Colloids Surf B Biointerfaces. 2007, 57: 189-197. 10.1016/j.colsurfb.2007.01.021.CrossRefPubMed

30.

Chanard J, Lavaud S, Randoux C, Rieu P: New insights in dialysis membrane biocompatibility: relevance of adsorption properties and heparin binding. Nephrol Dial Transplant. 2003, 18: 252-257. 10.1093/ndt/18.2.252.CrossRefPubMed

31.

van de Wetering J, Westendorp RG, van der Hoeven JG, Stolk B, Feuth JD, Chang PC: Heparin use in continuous renal replacement procedures: the struggle between filter coagulation and patient hemorrhage. J Am Soc Nephrol. 1996, 7: 145-150.PubMed

32.

Lavaud S, Canivet E, Wuillai A, Maheut H, Randoux C, Bonnet JM, Renaux JL, Chanard J: Optimal anticoagulation strategy in haemodialysis with heparin-coated polyacrylonitrile membrane. Nephrol Dial Transplant. 2003, 18: 2097-2104. 10.1093/ndt/gfg272.CrossRefPubMed

33.

Sperling C, Houska M, Brynda E, Streller U, Werner C: In vitro hemocompatibility of albumin-heparin multilayer coatings on polyethersulfone prepared by the layer-by-layer technique. J Biomed Mater Res A. 2006, 76: 681-689.CrossRefPubMed

34.

Dungen HD, von HC, Ronco C, Kox WJ, Spies CD: Renal replacement therapy: physical properties of hollow fibers influence efficiency. Int J Artif Organs. 2001, 24: 357-366.PubMed

35.

Bellomo R, Teede H, Boyce N: Anticoagulant regimens in acute continuous hemodiafiltration: a comparative study. Intensive Care Med. 1993, 19: 329-332. 10.1007/BF01694706.CrossRefPubMed

36.

Tan HK, Baldwin I, Bellomo R: Continuous veno-venous hemofiltration without anticoagulation in high-risk patients. Intensive Care Med. 2000, 26: 1652-1657. 10.1007/s001340000691.CrossRefPubMed

37.

Fiore G, Donadio PP, Gianferrari P, Santacroce C, Guermani A: CVVH in postoperative care of liver transplantation. Minerva Anestesiol. 1998, 64: 83-87.PubMed

38.

Uchino S, Fealy N, Baldwin I, Morimatsu H, Bellomo R: Continuous venovenous hemofiltration without anticoagulation. ASAIO J. 2004, 50: 76-80. 10.1097/01.MAT.0000104822.30759.A7.CrossRefPubMed

39.

Bastien O, French P, Paulus S, Filley S, Berruyer M, Dechavanne M, Estanove S: Antithrombin III deficiency during continuous venovenous hemodialysis. Contrib Nephrol. 1995, 116: 154-158.CrossRefPubMed

40.

Kutsogiannis DJ, Gibney RT, Stollery D, Gao J: Regional citrate versus systemic heparin anticoagulation for continuous renal replacement in critically ill patients. Kidney Int. 2005, 67: 2361-2367. 10.1111/j.1523-1755.2005.00342.x.CrossRefPubMed

41.

Joannes-Boyau O, Laffargue M, Honore P, Gauche B, Fleureau C, Roze H, Janvier G: Short filter life span during hemofiltration in sepsis: antithrombine (AT) supplementation should be a good way to sort out this problem. Blood Purif. 2005, 23: 149-174. 10.1159/000083654.CrossRef

42.

du Cheyron D, Bouchet B, Bruel C, Daubin C, Ramakers M, Charbonneau P: Antithrombin supplementation for anticoagulation during continuous hemofiltration in critically ill patients with septic shock: a case-control study. Crit Care. 2006, 10: R45-10.1186/cc4853.PubMedCentralCrossRefPubMed

43.

Esmon CT: The protein C pathway. Chest. 2003, 124: 26S-32S. 10.1378/chest.124.3_suppl.26S.CrossRefPubMed

44.

de Pont AC, Bouman CS, de Jonge E, Vroom MB, Büller HR, Levi M: Treatment with recombinant human activated protein C obviates additional anticoagulation during continuous venovenous hemofiltration in patients with severe sepsis. Intensive Care Med. 2003, 29: 1205-10.1007/s00134-003-1781-4.CrossRefPubMed

45.

Ricci Z, Ronco C, D'amico G, De Felice R, Rossi S, Bolgan I, Bonello M, Zamperetti N, Petras D, Salvatori G, et al: Practice patterns in the management of acute renal failure in the critically ill patient: an international survey. Nephrol Dial Transplant. 2006, 21: 690-696. 10.1093/ndt/gfi296.CrossRefPubMed

46.

De Waele JJ, Van Cauwenberghe S, Hoste E, Benoit D, Colardyn F: The use of the activated clotting time for monitoring heparin therapy in critically ill patients. Intensive Care Med. 2003, 29: 325-328.PubMed

47.

Hirsh J, Raschke R: Heparin and low-molecular-weight heparin: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004, 126: 188S-203S. 10.1378/chest.126.3_suppl.188S.CrossRefPubMed

48.

Warkentin TE, Levine MN, Hirsh J, Horsewood P, Roberts RS, Gent M, Kelton JG: Heparin-induced thrombocytopenia in patients treated with low-molecular-weight heparin or unfractionated heparin. N Engl J Med. 1995, 332: 1330-1335. 10.1056/NEJM199505183322003.CrossRefPubMed

49.

Elisaf MS, Germanos NP, Bairaktari HT, Pappas MB, Koulouridis EI, Siamopoulos KC: Effects of conventional vs. low-molecular-weight heparin on lipid profile in hemodialysis patients. Am J Nephrol. 1997, 17: 153-157.CrossRefPubMed

50.

Leitienne P, Fouque D, Rigal D, Adeleine P, Trzeciak MC, Laville M: Heparins and blood polymorphonuclear stimulation in haemodialysis: an expansion of the biocompatibility concept. Nephrol Dial Transplant. 2000, 15: 1631-1637. 10.1093/ndt/15.10.1631.CrossRefPubMed

51.

Jeffrey RF, Khan AA, Douglas JT, Will EJ, Davison AM: Anticoagulation with low molecular weight heparin (Fragmin) during continuous hemodialysis in the intensive care unit. Artif Organs. 1993, 17: 717-720.CrossRefPubMed

52.

Reeves JH, Cumming AR, Gallagher L, O'Brien JL, Santamaria JD: A controlled trial of low-molecular-weight heparin (dalteparin) versus unfractionated heparin as anticoagulant during continuous venovenous hemodialysis with filtration. Crit Care Med. 1999, 27: 2224-2228. 10.1097/00003246-199910000-00026.CrossRefPubMed

53.

Joannidis M, Kountchev J, Rauchenzauner M, Schusterschitz N, Ulmer H, Mayr A, Bellmann R: Enoxaparin versus unfractioned heparin for anticoagulation during continuous veno-venous hemofiltration – a randomized controlled cross-over study. Intensive Care Med. 2007 Jun 12,

54.

Isla A, Gascón AR, Maynar J, Arzuaga A, Corral E, Martín A, Solinís MA, Muñoz JL: In vitro and in vivo evaluation of enoxa-parin removal by continuous renal replacement therapies with acrylonitrile and polysulfone membranes. Clin Ther. 2005, 27: 1444-1451. 10.1016/j.clinthera.2005.09.008.CrossRefPubMed

55.

Greaves M: Limitations of the laboratory monitoring of heparin therapy. Scientific and Standardization Committee Communications: on behalf of the Control of Anticoagulation Subcommittee of the Scientific and Standardization Committee of the International Society of Thrombosis and Haemostasis. Thromb Haemost. 2002, 87: 163-164.PubMed

56.

Warkentin TE, Greinacher A: Heparin-induced thrombocytopenia: recognition, treatment, and prevention: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004, 126: 311S-337S. 10.1378/chest.126.3_suppl.311S.CrossRefPubMed

57.

Wester JP, Oudemans-van Straaten HM: How do I diagnose HIT?. Neth J Crit Care. 2006, 10: 61-65.

58.

Verma AK, Levine M, Shalansky SJ, Carter CJ, Kelton JG: Frequency of heparin-induced thrombocytopenia in critical care patients. Pharmacotherapy. 2003, 23: 745-753. 10.1592/phco.23.6.745.32188.CrossRefPubMed

59.

Wester JP, Leyte A, Oudemans-van Straaten HM, Bosman RJ, van der Spoel JI, Haak EA, Porcelijn L, Zandstra DF: Low-dose fondaparinux in suspected heparin-induced thrombocytopenia in the critically ill. Neth J Med. 2007, 65: 101-108.PubMed

60.

Vargas Hein O, von Heymann C, Lipps M, Ziemer S, Ronco C, Neumayer HH, Morgera S, Welte M, Kox WJ, Spies C: Hirudin versus heparin for anticoagulation in continuous renal replacement therapy. Intensive Care Med. 2001, 27: 673-679. 10.1007/s001340100907.CrossRefPubMed

61.

Magnani HN: Heparin-induced thrombocytopenia (HIT): an overview of 230 patients treated with orgaran (Org 10172). Thromb Haemost. 1993, 70: 554-561.PubMed

62.

Dager WE, White RH: Argatroban for heparin-induced thrombocytopenia in hepato-renal failure and CVVHD. Ann Pharmacother. 2003, 37: 1232-1236. 10.1345/aph.1D010.CrossRefPubMed

63.

Williamson DR, Boulanger I, Tardif M, Albert M, Gregoire G: Argatroban dosing in intensive care patients with acute renal failure and liver dysfunction. Pharmacotherapy. 2004, 24: 409-414. 10.1592/phco.24.4.409.33168.CrossRefPubMed

64.

Tang IY, Cox DS, Patel K, Reddy BV, Nahlik L, Trevino S, Murray PT: Argatroban and renal replacement therapy in patients with heparin-induced thrombocytopenia. Ann Pharmacother. 2005, 39: 231-236. 10.1345/aph.1E480.CrossRefPubMed

65.

Murray PT, Reddy BV, Grossman EJ, Hammes MS, Trevino S, Ferrell J, Tang I, Hursting MJ, Shamp TR, Swan SK: A prospective comparison of three argatroban treatment regimens during hemodialysis in end-stage renal disease. Kidney Int. 2004, 66: 2446-2453. 10.1111/j.1523-1755.2004.66022.x.CrossRefPubMed

66.

Fiaccadori E, Maggiore U, Rotelli C, Minari M, Melfa L, Cappè G, Cabassi A: Continuous haemofiltration in acute renal failure with prostacyclin as the sole anti-haemostatic agent. Intensive Care Med. 2002, 28: 586-593. 10.1007/s00134-002-1249-y.CrossRefPubMed

67.

Davenport A, Will EJ, Davison AM: Comparison of the use of standard heparin and prostacyclin anticoagulation in spontaneous and pump-driven extracorporeal circuits in patients with combined acute renal and hepatic failure. Nephron. 1994, 66: 431-437.CrossRefPubMed

68.

Kozek-Langenecker SA, Kettner SC, Oismueller C, Gonano C, Speiser W, Zimpfer M: Anticoagulation with prostaglandin E1 and unfractionated heparin during continuous venovenous hemofiltration. Crit Care Med. 1998, 26: 1208-1212. 10.1097/00003246-199807000-00021.CrossRefPubMed

69.

Kozek-Langenecker SA, Spiss CK, Gamsjager T, Domenig C, Zimpfer M: Anticoagulation with prostaglandins and unfractionated heparin during continuous venovenous haemofiltration: a randomized controlled trial. Wien Klin Wochenschr. 2002, 114: 96-101.PubMed

70.

Kozek-Langenecker SA, Spiss CK, Michalek-Sauberer A, Felfernig M, Zimpfer M: Effect of prostacyclin on platelets, polymorphonuclear cells, and heterotypic cell aggregation during hemofiltration. Crit Care Med. 2003, 31: 864-868. 10.1097/01.CCM.0000055374.77132.4D.CrossRefPubMed

71.

Bakker AJ, Boerma EC, Keidel H, Kingma P, van der Voort PH: Detection of citrate overdose in critically ill patients on citrate-anticoagulated venovenous haemofiltration: use of ionised and total/ionised calcium. Clin Chem Lab Med. 2006, 44: 962-966. 10.1515/CCLM.2006.164.CrossRefPubMed

72.

Chadha V, Garg U, Warady BA, Alon US: Citrate clearance in children receiving continuous venovenous renal replacement therapy. Pediatr Nephrol. 2002, 17: 819-824. 10.1007/s00467-002-0963-6.CrossRefPubMed

73.

Swartz R, Pasko D, O'Toole J, Starmann B: Improving the delivery of continuous renal replacement therapy using regional citrate anticoagulation. Clin Nephrol. 2004, 61: 134-143.CrossRefPubMed

74.

Kramer L, Bauer E, Joukhadar C, Strobl W, Gendo A, Madl C, Gangl A: Citrate pharmacokinetics and metabolism in cirrhotic and noncirrhotic critically ill patients. Crit Care Med. 2003, 31: 2450-2455. 10.1097/01.CCM.0000084871.76568.E6.CrossRefPubMed

75.

Meier-Kriesche HU, Gitomer J, Finkel K, DuBose T: Increased total to ionized calcium ratio during continuous venovenous hemodialysis with regional citrate anticoagulation. Crit Care Med. 2001, 29: 748-752. 10.1097/00003246-200104000-00010.CrossRefPubMed

76.

Mehta RL, McDonald BR, Aguilar MM, Ward DM: Regional citrate anticoagulation for continuous arteriovenous hemodialysis in critically ill patients. Kidney Int. 1990, 38: 976-981. 10.1038/ki.1990.300.CrossRefPubMed

77.

Ward DM, Mehta RL: Extracorporeal management of acute renal failure patients at high risk of bleeding. Kidney Int Suppl. 1993, 41: S237-S244.PubMed

78.

Tolwani AJ, Campbell RC, Schenk MB, Allon M, Warnock DG: Simplified citrate anticoagulation for continuous renal replacement therapy. Kidney Int. 2001, 60: 370-374. 10.1046/j.1523-1755.2001.00809.x.CrossRefPubMed

79.

Tobe SW, Aujla P, Walele AA, Oliver MJ, Naimark DM, Perkins NJ, Beardsall M: A novel regional citrate anticoagulation protocol for CRRT using only commercially available solutions. J Crit Care. 2003, 18: 121-129. 10.1053/jcrc.2003.50006.CrossRefPubMed

80.

Mitchell A, Daul AE, Beiderlinden M, Schafers RF, Heemann U, Kribben A, Peters J, Philipp T, Wenzel RR: A new system for regional citrate anticoagulation in continuous venovenous hemodialysis (CVVHD). Clin Nephrol. 2003, 59: 106-114.CrossRefPubMed

81.

Morgera S, Scholle C, Voss G, Haase M, Vargas-Hein O, Krausch D, Melzer C, Rosseau S, Zuckermann-Becker H, Neumayer HH: Metabolic complications during regional citrate anticoagulation in continuous venovenous hemodialysis: single-center experience. Nephron Clin Pract. 2004, 97: c131-c136. 10.1159/000079171.CrossRefPubMed

82.

Monchi M, Berghmans D, Ledoux D, Canivet JL, Dubois B, Damas P: Citrate vs. heparin for anticoagulation in continuous venovenous hemofiltration: a prospective randomized study. Intensive Care Med. 2004, 30: 260-265. 10.1007/s00134-003-2047-x.CrossRefPubMed

83.

Palsson R, Niles JL: Regional citrate anticoagulation in continuous venovenous hemofiltration in critically ill patients with a high risk of bleeding. Kidney Int. 1999, 55: 1991-1997. 10.1046/j.1523-1755.1999.00444.x.CrossRefPubMed

84.

Thoenen M, Schmid ER, Binswanger U, Schuepbach R, Aerne D, Schmidlin D: Regional citrate anticoagulation using a citrate-based substitution solution for continuous venovenous hemofiltration in cardiac surgery patients. Wien Klin Wochenschr. 2002, 114: 108-114.PubMed

85.

Hofmann RM, Maloney C, Ward DM, Becker BN: A novel method for regional citrate anticoagulation in continuous venovenous hemofiltration (CVVHF). Ren Fail. 2002, 24: 325-335. 10.1081/JDI-120005366.CrossRefPubMed

86.

Egi M, Naka T, Bellomo R, Cole L, French C, Trethewy C, Wan L, Langenberg CC, Fealy N, Baldwin I: A comparison of two citrate anticoagulation regimens for continuous veno-venous hemofiltration. Int J Artif Organs. 2005, 28: 1211-1218.PubMed

87.

Naka T, Egi M, Bellomo R, Cole L, French C, Botha J, Wan L, Fealy N, Baldwin I: Commercial low-citrate anticoagulation haemofiltration in high risk patients with frequent filter clotting. Anaesth Intensive Care. 2005, 33: 601-608.PubMed

88.

Bihorac A, Ross EA: Continuous venovenous hemofiltration with citrate-based replacement fluid: efficacy, safety, and impact on nutrition. Am J Kidney Dis. 2005, 46: 908-918. 10.1053/j.ajkd.2005.08.010.CrossRefPubMed

89.

Gabutti L, Marone C, Colucci G, Duchini F, Schonholzer C: Citrate anticoagulation in continuous venovenous hemodiafiltration: a metabolic challenge. Intensive Care Med. 2002, 28: 1419-1425. 10.1007/s00134-002-1443-y.CrossRefPubMed

90.

Dorval M, Madore F, Courteau S, Leblanc M: A novel citrate anticoagulation regimen for continuous venovenous hemodiafiltration. Intensive Care Med. 2003, 29: 1186-1189. 10.1007/s00134-003-1801-4.CrossRefPubMed

91.

Cointault O, Kamar N, Bories P, Lavayssiere L, Angles O, Rostaing L, Genestal M, Durand D: Regional citrate anticoagulation in continuous venovenous haemodiafiltration using commercial solutions. Nephrol Dial Transplant. 2004, 19: 171-178. 10.1093/ndt/gfg488.CrossRefPubMed

92.

Gupta M, Wadhwa NK, Bukovsky R: Regional citrate anticoagulation for continuous venovenous hemodiafiltration using calcium-containing dialysate. Am J Kidney Dis. 2004, 43: 67-73. 10.1053/j.ajkd.2003.09.014.CrossRefPubMed

93.

Bagshaw SM, Laupland KB, Boiteau PJ, Godinez-Luna T: Is regional citrate superior to systemic heparin anticoagulation for continuous renal replacement therapy? A prospective observational study in an adult regional critical care system. J Crit Care. 2005, 20: 155-161. 10.1016/j.jcrc.2005.01.001.CrossRefPubMed

94.

Van der Voort PH, Postma SR, Kingma WP, Boerma EC, Van Roon EN: Safety of citrate based hemofiltration in critically ill patients at high risk for bleeding: a comparison with nadroparin. Int J Artif Organs. 2006, 29: 559-563.PubMed

95.

Spronk PE, Steenbergen H, ten Kleij M, Rommes JH: Re: Regional citrate anticoagulation does not prolong filter survival during CVVH. J Crit Care. 2006, 21: 291-292. 10.1016/j.jcrc.2006.02.002.CrossRefPubMed

96.

Gabutti L, Ferrari N, Mombelli G, Keller F, Marone C: The favorable effect of regional citrate anticoagulation on interleukin-1beta release is dissociated from both coagulation and complement activation. J Nephrol. 2004, 17: 819-825.PubMed

97.

Bos JC, Grooteman MP, van Houte AJ, Schoorl M, van Limbeek J, Nubé MJ: Low polymorphonuclear cell degranulation during citrate anticoagulation: a comparison between citrate and heparin dialysis. Nephrol Dial Transplant. 1997, 12: 1387-1393. 10.1093/ndt/12.7.1387.CrossRefPubMed

98.

Gritters M, Grooteman MP, Schoorl M, Schoorl M, Bartels PC, Scheffer PG, Teerlink T, Schalkwijk CG, Spreeuwenberg M, Nubé MJ: Citrate anticoagulation abolishes degranulation of polymorphonuclear cells and platelets and reduces oxidative stress during haemodialysis. Nephrol Dial Transplant. 2006, 21: 153-159. 10.1093/ndt/gfi069.CrossRefPubMed

99.

Wang PL, Meyer MM, Orloff SL, Anderson S: Bone resorption and "relative" immobilization hypercalcemia with prolonged continuous renal replacement therapy and citrate anticoagulation. Am J Kidney Dis. 2004, 44: 1110-1114. 10.1053/j.ajkd.2004.09.001.CrossRefPubMed

Title: Clinical review: Patency of the circuit in continuous renal replacement therapy
Authors: Michael Joannidis
Heleen M Oudemans-van Straaten
Publication date: 01-08-2007
Publisher: BioMed Central
Published in: Critical Care / Issue 4/2007
Electronic ISSN: 1364-8535
DOI: https://doi.org/10.1186/cc5937

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Clinical review: Patency of the circuit in continuous renal replacement therapy

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

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Number needed to treat = six: therapeutic hypothermia following cardiac arrest – an effective and cheap approach to save lives

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Between prediction, education, and quality control: simulation models in critical care

Nasogastric tube incidents and the use of the 'whoosh test'

Caudwell Xtreme Everest: a field study of human adaptation to hypoxia