No Monitoring of Post-filter Ionized Calcium in Regional Citrate Anticoagulation

Chulalongkorn University

Status: Completed

Conditions: Regional Citrate Anticoagulation; Continuous Renal Replacement Therapy; Ionized Calcium

Treatments: Drug: Antibiotic; Other: Regional citrate anticoagulation; Drug: Vasopressor; Device: Dialysis with continuous renal replacement therapy

Study type: Interventional

Funder types: Other

Identifiers

NCT04792424

IRB.35/64

Details and patient eligibility

About

Do no monitor of post-circuit ionized calcium affact the filter life time of continueous renal replacement therapy with regional citrate anticoagulation circuit? A randomized control trial

Full description

Regional citrate anticoagulation is the gold standard of anticoagulation in patient receiving CRRT. In RCA circuit, there was a monitoring of pre-filter (systemic) ionized calcium and post-filter (circuit) ionized calcium. Pre-filter ionized calcium was monitored for observe the adverse effect of citrate such as hypocalcemia, citrate intoxication. However, post-filter ionized calcium was monitored for adjustment the citrate dose. We find many problem with frequently monitoring of post-ionized calcium such as confusion from markedly abnormal result, how to adjustment the citrate dose ,and increase workload for nurses. We hypothesis that if we can monitoring of post-filter ionized calcium?

Enrollment: 50 patients

Sex: All

Ages: 18+ years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• Age older than 18 years old and admission in an ICU
• Indication for CRRT
• regional citrate anticoagulation

Exclusion criteria

• Acute liver failure defined as AST or ALT > 5X UNL or TB/DB > 5X UNL or evidence of cirrhosis
• Severe persistent lactic acidosis (lactate persist > 8 mg/dL consecutively within 6 hours)
• Receiving heparin anticoagulation
• Severe alkalosis (pH>7.55) or acidosis (pH<7.1)
• History of renal allograft
• Known pregnancy
• Patient is moribund with expected death within 24 hr
• Deficiency of ionzed calcium (Cation < 0.8 mmol/L)

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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50 participants in 2 patient groups, including a placebo group

No monitoring of post filter ionized calcium

Experimental group

Description:

Starting dialysis with continuous renal replacement therapy with regional citrate anticoagulation. Patients will receive standard treatments such as anti-bacterial agents, mechanical ventilator, vasopressors as appropriate. Citrate dose start at 4 mmol/L and no adjustment of citrate dose. Post-filter ionized calcium result will blind for physician. Other laboratory such as pre-filter ionized calcium, electrolyte, ABG, calcium, the ratio of total calcium to systemic ionized calcium will monitor every 8 hour.

Treatment:

Device: Dialysis with continuous renal replacement therapy

Drug: Antibiotic

Other: Regional citrate anticoagulation

Drug: Vasopressor

Monitoring of post filter ionized calcium

Placebo Comparator group

Description:

Starting dialysis with continuous renal replacement therapy with regional citrate anticoagulation. Patients will receive standard treatments such as anti-bacterial agents, mechanical ventilator, vasopressors as appropriate. Citrate dose start at 4 mmol/L with adjustment of citrate dose to acheive post-filter ionized calcium at 0.25-0.35 mmol/L. Other laboratory such as pre-filter ionized calcium, electrolyte, ABG, calcium, the ratio of total calcium to systemic ionized calcium will monitor every 8 hour.

Treatment:

Device: Dialysis with continuous renal replacement therapy

Drug: Antibiotic

Other: Regional citrate anticoagulation

Drug: Vasopressor