A new prescription model for regional citrate anticoagulation in therapeutic plasma exchanges

BMC Nephrology

Technical Advance

Cécile Legallais¹  Daniel Teta²  Menno Pruijm²  Michel Burnier²  Bruno Vogt²  Christophe Ridel³  Eric Rondeau³  Sébastien Kissling⁴ 

[1] Biomécanique et Bioingénierie, Université de Technologie de Compiègne (UTC), UMR CNRS 7338, 60203, Compiègne, France;Service de Néphrologie et Hypertension, Centre Hospitalier Universitaire Vaudois (CHUV), Rte du Bugnon 17, 1011, Lausanne, CH, Switzerland;Service d’Urgences néphrologiques et Transplantation rénale (UNTR), Hôpital Tenon, 75020, Paris, France;Service d’Urgences néphrologiques et Transplantation rénale (UNTR), Hôpital Tenon, 75020, Paris, France;Biomécanique et Bioingénierie, Université de Technologie de Compiègne (UTC), UMR CNRS 7338, 60203, Compiègne, France;Service de Néphrologie et Hypertension, Centre Hospitalier Universitaire Vaudois (CHUV), Rte du Bugnon 17, 1011, Lausanne, CH, Switzerland;

关键词: Citrate;    Clinical protocol;    Drug prescription;    Mathematical model;    Plasma exchanges;   

DOI  :  10.1186/s12882-017-0494-9

 received in 2016-10-04, accepted in 2017-02-21,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundRegional citrate anticoagulation (RCA) is proposed for various extracorporeal purification techniques to overcome the risk of bleeding that might result from systemic anticoagulation. Yet, no individualized treatment protocol has been proposed for therapeutic plasma exchange (TPE) so far. The objective of this study was to assess the determinants of blood citrate concentration needed and to develop an individualized RCA protocol useful for clinical practice.MethodsThe study population included 14 patients who underwent a total of 47 TPE sessions. Citrate was infused pre-plasmafilter. Post-plasmafilter and systemic plasma ionized calcium concentrations were measured at standardized time intervals. An algorithm was proposed for the supplementation of calcium. During the discovery phase, citrate was infused at a fixed starting rate, and adapted accordingly to obtained post-plasmafilter ionized calcium levels. Using a mathematical approach, an algorithm was thereafter developed for individualized prescriptions of citrate.ResultsPre-treatment values of hematocrit and plasma ionized calcium were the main determinants of the required rate of citrate infusion. These can be integrated into a final equation enabling to individualize the prescription. A prefilter ionized calcium concentration between 0.24 and 0.33 mmol/l prevented coagulation of the extracorporeal circuit. Significant hypocalcemia occurred in 8.5% of treatments. There were no significant acid–base disturbances.ConclusionWe propose a new protocol, which enables for the first time to individualize the prescription of regional citrate anticoagulation during TPE, in an efficient manner. The immediately obtained regional anticoagulation protects against both the risk of coagulation of the membrane and the exposure to an excess of citrate.

【 授权许可】

CC BY   
© The Author(s). 2017