Citrate anticoagulation during CVVH in high risk bleeding patients

Lucia Cubattoli, M. Teruzzi, M. Cormio, L. Lampati, A. Pesenti

Research output: Contribution to journalArticlepeer-review


Background: Regional citrate anticoagulation (RCA) is an effective form of anticoagulation for continuous renal replacement therapy (CRRT) in patients with contraindications to heparin. Its use has been very limited, possibly because of the need for special infusion solutions and difficult monitoring of the metabolic effects. Objective: To investigate the safety and the feasibility of an RCA method for continuous veno-venous hemofiltration (CVVH) using commercially available replacement fluid. Methods: We evaluated 11 patients at high risk of bleeding, requiring CVVH. RCA was performed using commercially available replacement fluid solutions to maintain adequate acid-base balance. We adjusted the rate of citrate infusion to achieve a post-filter ionized calcium concentration [iCa] 250 ml/min. When needed, we infused calcium gluconate to maintain systemic plasma [iCa] within the normal range. Results: Twenty-nine filters ran for a total of 965.5 h. Average filter life was 33.6±20.5 h. Asymptomatic hypocalcemia was detected in 6.9% of all samples. No [iCa] values

Original languageEnglish
Pages (from-to)244-252
Number of pages9
JournalInternational Journal of Artificial Organs
Issue number3
Publication statusPublished - Mar 2007


  • Acute renal failure
  • Bleeding complications
  • Citrate toxicity
  • Hemofiltration
  • Trisodium citrate

ASJC Scopus subject areas

  • Biophysics


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