Regional citrate anticoagulation continuous venous-venous hemodialysis in acute hepatic & kidney injury after cardiovascular surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

QIAN Cheng ,  GU Tianxiang , XIU Zongyi , WANG Chun , JIN Na , GAI Fengqin , JIN Yan

Department of Cardiovascular Surgery, The First Hospital of China Medical University, Shenyang, 110001, P.R.China;

Corresponding author：

GU Tianxiang, Email: cmugtx@sina.com

Keywords：

Regional citrate anticoagulation; continuous venous-venous hemodialysis; acute hepatic injury

DOI：

10.7507/1007-4848.201512007

Video：

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Objective To investigate the effects and feasibility of regional citrate anticoagulation continuous venous-venous hemodialysis(RCA-CVVHD) in acute hepatic & kidney injury after cardiovascular surgery. Methods Ten patients with acute kidney injury combined with acute hepatic injury after cardiovascular surgery were involved in this study. There were 5 males and 5 females at age of 35-69(58.2±12.7) years. All of them were treated by RCA-CVVHD. Blood samples were collected before treatment, 12 h, 24 h, 48 h, and 72 h after treatment. Results There was no statistical difference between post- and pre-treatment regarding with pH value (7.47±0.12 vs. 7.50±0.06 vs. 7.48±0.04 vs. 7.48±0.03 vs. 7.45±0.05, P>0.05) or BE value (0.91±9.97 mmol/L vs. 2.36±3.92 mmol/L vs. –0.22±3.09 mmol/L vs. 1.87±3.58 mmol/L vs. –1.05±1.12 mmol/L, P>0.05). There was a statistical difference in iCa (1.09±0.09 mmol/L vs. 1.15±0.08 mmol/L vs. 1.17±0.08 mmol/L vs. 1.24±0.09 mmol/L vs. 1.16±0.06 mmol/L), Na⁺ (149.44±6.84 mmol/L vs. 144.33±3.35 mmol/L vs. 143.13±3.52 mmol/L vs.141.25±5.52 mmol/L vs. 136.71±4.92 mmol/L), and tCa/iCa (2.07±0.11 vs. 2.10±1.12 vs. 2.17±0.69 vs. 2.23±1.05 vs. 2.30±0.11), respectively. Conclusion RCA-CVVHD used in patients with acute hepatic impairment is safe and feasible.

Citation： QIAN Cheng, GU Tianxiang, XIU Zongyi, WANG Chun, JIN Na, GAI Fengqin, JIN Yan. Regional citrate anticoagulation continuous venous-venous hemodialysis in acute hepatic & kidney injury after cardiovascular surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(8): 607-610. doi: 10.7507/1007-4848.201512007 Copy

1.	Ronco C. Continuous dialysis is superior to intermittent dialysis in acute kidney injury of the critically ill patient. Nat Clin Pract Nephrol, 2007, 3(3): 118-119.
2.	Schultheiß C, Saugel B, Phillip V, et al. Continuous venovenous hemodialysis with regional citrate anticoagulation in patients with liver failure: a prospective observational study. Crit Care, 2012, 16(4): R162.
3.	Wu MY, Hsu YH, Bai CH, et al. Regional citrate versus heparin anticoagulation for continuous renal replacement therapy: a meta-analysis of randomized controlled trials. Am J Kidney Dis, 2012, 59(6): 810-818.
4.	Oudemans-van Straaten HM, Ostermann M. Bench-to-bedside review: Citrate for continuous renal replacement therapy, from science to practice. Critical Care, 2012, 16(6): 249.
5.	Tolwani A, Wille KM. Advances in continuous renal replacement therapy: citrate anticoagulation update. Blood Purif, 2012, 34(2): 88-93.
6.	Oudermans-van Straaten HM, Kellum JA, Bellomo R. Clinical review: anticoagulation for continuous renal replacement therapy-heparin or citrate. Crit Care, 2011, 15(1): 202.
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8.	Ghosh S, Roberts N, Fimain RK, et al. Risk factors for intestinal ischaemia in cardiac surgical patients. Eur J Cardiothorac Surg, 2002, 21(3): 411-416.
9.	许卫江, 刘彬, 陈昌. 体外循环心脏术后急性肝功能损害的危险因素分析. 心血管康复医学杂志, 2008, 17(4): 370-372.
10.	Perugini RA, Orr RK, Porter D, et al. Gastrointestinal complications following cardiac surgery. An analysis of 1477 cardiac surgery patients. Arch Surg, 1997, 132(4): 352-357.
11.	Kaplan M, Cimen S, Kut MS, et al. Cardiac operations for patients with chronic liver disease. Heart Surg Forum, 2002, 5(1): 60-65.
12.	Almdahl SM, Rynning SE, Veel T, et al. Postoperatively increased serum alanine aminotransferase level is closely associated with mortality after cardiac surgery. Thorac Cardiovasc Surg, 2015, 63(1): 67-72.
13.	Schilder L, Nurmohamed SA, Bosch FH, et al. Citrate anticoagulation versus systemic heparinisation in continuous venovenous hemofiltration in critically ill patients with acute kidney injury: a multi-center randomized clinical trial. Critical Care, 2014, 18(4): 472.
14.	Kalb R, Kram R, Morgera S, et al. Regional citrate anticoagulation for high volume continuous venovenous hemodialysis in surgical patients with high bleeding risk. Ther Apher Dial, 2013, 17(2): 202-212.
15.	Gong D, Ji D, Xu B, et al. Regional citrate anticoagulation in critical ill patients during continuous blood purification. Chin Med J (Engl), 2003, 116(3): 360-363.
16.	Morgera S, Scholle C, Ruckert M, et al. Regional citrate anticoagulation in continuous hemodialysis-acid-base and electrolyte balance at an increased dose of dialysis. Nephron Clin Pract, 2005, 101(4): c211-c219.
17.	Morgera S, Schneider M, Slowinski T, et al. A safe citrate anticoagulation protocol with variable treatment efficacy and excellent control of acid-base status. Crit Care Med, 2009, 37(6): 2018-2024.

1. Ronco C. Continuous dialysis is superior to intermittent dialysis in acute kidney injury of the critically ill patient. Nat Clin Pract Nephrol, 2007, 3(3): 118-119.
2. Schultheiß C, Saugel B, Phillip V, et al. Continuous venovenous hemodialysis with regional citrate anticoagulation in patients with liver failure: a prospective observational study. Crit Care, 2012, 16(4): R162.
3. Wu MY, Hsu YH, Bai CH, et al. Regional citrate versus heparin anticoagulation for continuous renal replacement therapy: a meta-analysis of randomized controlled trials. Am J Kidney Dis, 2012, 59(6): 810-818.
4. Oudemans-van Straaten HM, Ostermann M. Bench-to-bedside review: Citrate for continuous renal replacement therapy, from science to practice. Critical Care, 2012, 16(6): 249.
5. Tolwani A, Wille KM. Advances in continuous renal replacement therapy: citrate anticoagulation update. Blood Purif, 2012, 34(2): 88-93.
6. Oudermans-van Straaten HM, Kellum JA, Bellomo R. Clinical review: anticoagulation for continuous renal replacement therapy-heparin or citrate. Crit Care, 2011, 15(1): 202.
7. 吴阶平, 裘法祖, 主编. 黄家驷外科学. 第6版. 北京: 人民卫生出版社, 2005. 406.
8. Ghosh S, Roberts N, Fimain RK, et al. Risk factors for intestinal ischaemia in cardiac surgical patients. Eur J Cardiothorac Surg, 2002, 21(3): 411-416.
9. 许卫江, 刘彬, 陈昌. 体外循环心脏术后急性肝功能损害的危险因素分析. 心血管康复医学杂志, 2008, 17(4): 370-372.
10. Perugini RA, Orr RK, Porter D, et al. Gastrointestinal complications following cardiac surgery. An analysis of 1477 cardiac surgery patients. Arch Surg, 1997, 132(4): 352-357.
11. Kaplan M, Cimen S, Kut MS, et al. Cardiac operations for patients with chronic liver disease. Heart Surg Forum, 2002, 5(1): 60-65.
12. Almdahl SM, Rynning SE, Veel T, et al. Postoperatively increased serum alanine aminotransferase level is closely associated with mortality after cardiac surgery. Thorac Cardiovasc Surg, 2015, 63(1): 67-72.
13. Schilder L, Nurmohamed SA, Bosch FH, et al. Citrate anticoagulation versus systemic heparinisation in continuous venovenous hemofiltration in critically ill patients with acute kidney injury: a multi-center randomized clinical trial. Critical Care, 2014, 18(4): 472.
14. Kalb R, Kram R, Morgera S, et al. Regional citrate anticoagulation for high volume continuous venovenous hemodialysis in surgical patients with high bleeding risk. Ther Apher Dial, 2013, 17(2): 202-212.
15. Gong D, Ji D, Xu B, et al. Regional citrate anticoagulation in critical ill patients during continuous blood purification. Chin Med J (Engl), 2003, 116(3): 360-363.
16. Morgera S, Scholle C, Ruckert M, et al. Regional citrate anticoagulation in continuous hemodialysis-acid-base and electrolyte balance at an increased dose of dialysis. Nephron Clin Pract, 2005, 101(4): c211-c219.
17. Morgera S, Schneider M, Slowinski T, et al. A safe citrate anticoagulation protocol with variable treatment efficacy and excellent control of acid-base status. Crit Care Med, 2009, 37(6): 2018-2024.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Regional citrate anticoagulation continuous venous-venous hemodialysis in acute hepatic & kidney injury after cardiovascular surgery

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