Premium
Sustained low‐efficiency dialysis with regional citrate anticoagulation for patients with liver impairment in intensive care unit: A single‐center experience
Author(s) -
Pourcine Franck,
Vong Ly Van Phach,
Chelly Jonathan,
Rollin Nathalie,
Sy Oumar,
Jochmans Sebastien,
Ellrodt Olivier,
SerbourceGoguel Jean,
Mazerand Sandie,
Michaud Gael,
Nlandu Yannick,
Cirillo Giulia,
Vinsonneau Christophe,
Monchi Mehran
Publication year - 2021
Publication title -
therapeutic apheresis and dialysis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.415
H-Index - 53
eISSN - 1744-9987
pISSN - 1744-9979
DOI - 10.1111/1744-9987.13538
Subject(s) - medicine , intensive care unit , renal replacement therapy , extracorporeal , retrospective cohort study , dialysis , acute kidney injury , single center , cirrhosis , intensive care medicine , gastroenterology
Regional citrate anticoagulation (RCA) is a recommended method for extracorporeal circuit anticoagulation during renal replacement therapy (RRT). Increased risk of citrate accumulation by default of hepatic metabolism limits its use in liver failure patients. A Ca tot /Ca ion ratio ≥2.5 is established as an indirect control of plasma citrate poisoning. To investigate the safety of RCA in patients with liver impairment during sustained low‐efficiency dialysis (SLED), we conducted a retrospective study of 41 patients with acute or chronic hepatocellular failure requiring RRT between January 2014 and June 2015 in the intensive care unit of the Groupe Hospitalier Sud Ile de France. Sixty‐seven SLED sessions were performed. At admission, 32 (78%) patients had acute liver dysfunction and nine (22%) patients had cirrhosis with a median MELD score of 27 (IQR: 18.8, 42.0). Despite a majority of poor prognosis patients (SAPS‐II (Simplified Acute Physiology Score II) score 71 [IQR: 58; 87]), with acute liver impairment as a part of multi‐organ failure, no dosage of Ca tot /Ca ion ratio after SLED sessions exceeded the critical threshold of 2.5. Of the 63 complete sessions, neither dyscalcemia nor major dysnatremia, nor extracorporeal circuit thrombosis were noticed. Observed acid‐base disturbances (16.4%) were not significantly correlated with the Ca tot /Ca ion ratio ( P = .2155). In this retrospective study using RCA during intermittent RRT in ICU patients with severe liver dysfunction, we did not observe any citrate accumulation but monitoring of acid‐base status and electrolytes remains necessary to ensure technique safety.