{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T22:14:28Z","timestamp":1792620868976,"version":"4.5.0"},"reference-count":45,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,7,2]],"date-time":"2021-07-02T00:00:00Z","timestamp":1625184000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,7,2]],"date-time":"2021-07-02T00:00:00Z","timestamp":1625184000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Nephrol"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Regional citrate anticoagulation (RCA) for the prevention of clotting of the extracorporeal blood circuit during continuous kidney replacement therapy (CKRT) has been employed in limited fashion because of the complexity and complications associated with certain protocols. Hypertonic citrate infusion to achieve circuit anticoagulation results in variable systemic citrate- and sodium load and increases the risk of citrate accumulation and hypernatremia. The practice of \u201csingle starting calcium infusion rate for all patients\u201d puts patients at risk for clinically significant hypocalcemia if filter effluent calcium losses exceed replacement. A fixed citrate to blood flow ratio, personalized effluent and pre-calculated calcium infusion dosing based on tables derived through kinetic analysis enable providers to use continuous veno-venous hemo-diafiltration (CVVHDF)-RCA in patients with liver citrate clearance of at least 6\u2009L\/h.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>This was a single-center prospective observational study conducted in intensive care unit patients triaged to be treated with the novel pre-calculated CVVHDF-RCA \u201cNon-shock\u201d protocol. RCA efficacy outcomes were time to first hemofilter loss and circuit ionized calcium (iCa) levels. Safety outcomes were surrogate of citrate accumulation (TCa\/iCa ratio) and the incidence of acid-base and electrolyte complications.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Of 53 patients included in the study, 31 (59%) had acute kidney injury and 12 (22.6%) had the diagnosis of cirrhosis at the start of CVVHDF-RCA. The median first hemofilter life censored for causes other than clotting exceeded 70\u2009h. The cumulative incidence of hypernatremia (Na &gt;\u2009148\u2009mM), metabolic alkalosis (HCO3- &gt;\u200930\u2009mM), hypocalcemia (iCa &lt;\u20090.9\u2009mM) and hypercalcemia (iCa &gt;\u20091.5\u2009mM) were 1\/47 (1%), 0\/50 (0%), 1\/53 (2%), 1\/53 (2%) respectively and were not clinically significant. The median (25th\u201375th percentile) of the highest TCa\/iCa ratio for every 24-h interval on CKRT was 1.99 (1.91\u20132.13).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>The fixed citrate to blood flow ratio, as opposed to a titration approach, achieves adequate circuit iCa (&lt;\u20090.4\u2009mm\/L) for any hematocrit level and plasma flow. The personalized dosing approach for calcium supplementation based on pre-calculated effluent calcium losses as opposed to the practice of \u201cone starting dose for all\u201d reduces the risk of clinically significant hypocalcemia. The fixed flow settings achieve clinically desirable steady state systemic electrolyte levels.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12882-021-02443-6","type":"journal-article","created":{"date-parts":[[2021,7,2]],"date-time":"2021-07-02T08:03:07Z","timestamp":1625212987000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Regional citrate anticoagulation \u201cnon-shock\u201d protocol with pre-calculated flow settings for patients with at least 6\u2009L\/hour liver citrate clearance"],"prefix":"10.1186","volume":"22","author":[{"given":"Lenar","family":"Yessayan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryann","family":"Sohaney","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vidhit","family":"Puri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Wagner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy","family":"Riddle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharon","family":"Dickinson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lena","family":"Napolitano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Heung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Humes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Balazs","family":"Szamosfalvi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,7,2]]},"reference":[{"key":"2443_CR1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1038\/kisup.2012.1","volume":"2","author":"Kidney Disease: Improving global outcomes (KDIGO) acute kidney injury workgroup","year":"2012","unstructured":"Kidney Disease: Improving global outcomes (KDIGO) acute kidney injury workgroup. 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All methods were carried out in accordance with relevant guidelines and regulations.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"All authors consent to publish. There are no clinical details of participants or publication of identifying images or other personal data that compromise anonymity","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"M. Heung reports Consultancy Agreements: Potrero Medical, Inc., Baxter Inc., Wolters Kluwer (Lexicomp); Research Funding: VA, CDC, PCORI; Honoraria: NKF; Scientific Advisor or Membership: Associate Editor\/Editorial board, Advances in Chronic Kidney Disease. H. Humes reports Consultancy Agreements: SeaStar Medical; Ownership Interest: Innovative BioTherapies, Inc., SeaStar Medical, Inc.; Research Funding: Innovative Biotherapies, Renal Research Institute, SeaStar Medical, Sygin, Lowell Pharmaceuticals; Scientific Advisor or Membership: Innovative Biotherapies, SeaStar Medical. B. Szamosfalvi reports Research Funding: Renal Research Institute. B. Wagner reports Ownership Interest: Able-Wagner, Inc. Lenar Yessayan reports Scientific Advisor or Membership: Section Editor, Renal and Extracorporeal Blood Treatment ASAIO Journal. All remaining authors have nothing to disclose.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"244"}}