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Regional citrate anticoagulation for continuous renal replacement therapy in newborns and infants: Focus on citrate accumulation

机译：用于新生儿和婴幼儿连续肾脏替代治疗的区域柠檬酸盐抗凝：专注于柠檬酸盐积累

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Abstract Continuous renal replacement therapy (CRRT) with regional citrate anticoagulation (RCA) in newborns and infants is challenging and accumulation of citrate can occur. There are only a few studies reporting the detailed data on RCA. We aimed to analyze RCA‐CRRT at our institution with focus on citrate accumulation. Critically ill newborns and infants up to 11 kg of body weight (BW), treated with RCA‐CRRT in the 2011‐2016 period were included in this retrospective observational study. Prismaflex(R) and Multifiltrate‐CiCa(R) dialysis monitors were used with either automated or manual RCA. Data was collected regarding the circuit lifetime, parameters of RCA, markers of citrate accumulation (total/ionized calcium ratio 2.5), and metabolic complications. We included 10 children with mean age of 2.6?±?3.8 months and BW of 4.6?±?2.7 kg. In‐hospital mortality was 60%. RCA‐CRRT parameters were: blood flow 46?±?9 mL/min (12?±?5 mL/min/kg BW), citrate dose 2.8?±?0.6 mmol/L of blood resulting in estimated citrate load to the patient of 1.7?±?0.8 mmol/h/kg BW. In total, 57 dialysis circuits were used with mean filter lifetime of 39?±?29 h. Citrate accumulation (total/ionized calcium ratio 2.5) was observed in 7/10 patients and in 14/57 (25%) of circuits; those circuits were performed in children with lower age and BW, had higher relative blood flow and citrate load, while citrate dose was similar. When citrate load to the patient was used to predict citrate accumulation, AUC under the ROC curve was 0.78 and 1.7 mmol/h/kg BW was considered the optimal cutoff value (sensitivity 71% and specificity 72%). CRRT with RCA using equipment, developed for adult population, is feasible in newborns and infants. Signs of citrate accumulation developed relatively often. To prevent it, we suggest avoiding citrate loads above 1.7 mmol/h/kg BW, which can best be achieved by keeping the blood flow below 9 mL/min/kg BW.
机译：摘要在新生儿和婴儿中，具有区域柠檬酸盐抗凝（RCA）的连续肾置换疗法（RCA）是挑战性和柠檬酸盐的积累。只有一些研究报告了RCA上的详细数据。我们旨在分析我们的机构的RCA-CRRT，重点是柠檬酸盐积累。在这项回顾性的观察研究中，在2011-2016期间治疗的危重新生儿和婴儿高达11公斤体重（BW）的体重（BW）。 Prismaflex（R）和多滤液-CICA（R）透析显示器与自动化或手动RCA一起使用。关于电路寿命，RCA参数，柠檬酸盐累积标记的数据（总/电离钙率，GT; 2.5）和代谢并发症。我们包括10名平均年龄为2.6的儿童？±3.8个月，BW为4.6？±2.7千克。在医院死亡率为60％。 RCA-CRRT参数是：血流46？±9ml / min（12？±5ml / min / kg bw），柠檬酸剂剂量2.8？±0.6mmol / L血液导致患者估计柠檬酸盐负荷1.7？±0.8mmol / h / kg bw。总共使用57个透析电路，平均过滤器寿命为39？±29小时。 7/10患者和14/57（25％）电路中观察到柠檬酸盐积聚（总/离子化钙比率＆ 2.5）;这些电路在较低年龄和BW的儿童中进行，具有更高的相对血流和柠檬酸盐负荷，而柠檬酸剂量相似。当柠檬酸盐负荷用于预测柠檬酸盐积累时，ROC曲线下的AUC为0.78且1.7mmol / h / kg BW被认为是最佳截止值（灵敏度71％和特异性72％）。使用RCA使用用于成人人群的设备的CRRT是可行的，在新生儿和婴儿中是可行的。柠檬酸盐积累的迹象相对较长。为了防止它，我们建议避免高于1.7mmol / h / kg Bw以上的柠檬酸盐载荷，这最好通过将血液流量保持在9ml / min / kg bw以下来实现。

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