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Regional citrate anticoagulation (RCA) is becoming the preferred method of extracorporeal anticoagulation in patients undergoing continuous renal replacement therapy (CRRT), however the ideal composition remains unclear. We have found protocolised hemofiltration with dilute solutions to be simple and safe, but commercially available solution options are limited. Recently the 14 mmol/L solution (Baxter Haemofiltration Fluid [C14]) was replaced in Australia with 18 mmol/L solution [C18], on the premise that the former provided inadequate anticoagulation. With the use of the C18 solution, a higher incidence of metabolic alkalosis was observed, prompting the design of a biochemically modified solution which would provide optimal anticoagulation, but less biochemical disturbance.

intensive care medicine experimental

A comparison between 2 dilute citrate solutions (15mmol/l vs 18 mmol/l) in continuous renal replacement therapy: the base excess and renal replacement solution (BEARRS) study