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The investigators designed a monitoring and control table of a citrate treatment on a specific monitor. This is the Baxter "Prismaflex" monitor, with 8.2 software version. Dialysis bath liquids marketed by Baxter: Biphozyl are used. Citrate liquid (1:18) Regiocit is used.
The dialysis treatment monitor (CVVHD) is programmed, with a blood / citrate pumps at a rate of 1:10 (1 ml / min of blood: 10 ml / h of dialysis fluid) The starting dose of citrate will be 3.5 mmol / l and the calcium compensation will be 100% Working hypothesis: The patient undergoing citrate anticoagulation according to the designed algorithm will respond with ion stability and pH during the treatment, in addition to achieving an effective cleaning process.
Study design: quasi-experimental design. two groups:
Study population Inclusión/exclusion criteria:
Adult patients (regardless of their underlying pathology), who develop acute renal failure, admitted to the ICU of St Pau Hospital with the Intensive Medicine medical team, who require citrate anticoagulation in continuous dialysis therapy and are treated with Baxter "Prismaflex" monitor.
Patients who meet the criteria described above will be followed up in this study.
Expected sample size:
It is estimated that with 24/12 (group1/2) patients will be enough to achieve our goal
Methodology. Information sources:
The start of the treatment with Baxter citrate will be given according to the patient's need and subject to a basic medical decision. From here the research team will enter. The investigation team will never influence the medical decision.
Since such a treatment is started, the main investigator will assign a number to the dialysis circuit and will be followed, every six hours, for the most important variables. The rest of the variables will be collected at least once a day and according to the patient's situation.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Diluted citrate | Experimental | Initial citrate dose 3.5 mmol/L Initial calcium programmed 100% ("compensation dose") only dialysis and ratio 1:10 (blood/dialysis) No fluids in the repositioning scale |
|
| Concentrated citrate | Active Comparator | Initial citrate dose: 3.5 mmol/L Initial calcium dose: 1.9 mmol/L and 1:20 ratio (blood/dialysis) No convection programmed |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| the same citrate dosification in both types | Other | match concentrated and dilute citrate protocol |
|
| Measure | Description | Time Frame |
|---|---|---|
| Dialysis flow | Speed at which the dialysis fluid pump is programmed in the circuit and measured in milliliters / hour | 6 hours |
| Blood flow | Speed at which the blood pump is programmed in the dialysis circuit and measured in milliliters / min | 6 hours |
| Citrate dose | Relationship that exists between the liquid we infuse (which contains 18mmol / L citrate) and the blood pump. It is measured in mmol citrate / liter of blood | 6 hours |
| Calcium dose | Amount of calcium that is replenished to the patient when the dialyzed blood is returned. It is measured in%. | 6 hours |
| Measure | Description | Time Frame |
|---|---|---|
| Filter operating hours | They correspond to the hours that go from the beginning of the circuit until the end of the circuit in which the fungible is discarded. It can be several days | number of hours |
| Arterial pH |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Fundació de Gestió Sanità ria de l'Hospital de la Santa Creu i Sant Pau | Barcelona | 08041 | Spain |
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| ID | Term |
|---|---|
| D058186 | Acute Kidney Injury |
| ID | Term |
|---|---|
| D051437 | Renal Insufficiency |
| D007674 | Kidney Diseases |
| D014570 | Urologic Diseases |
| D052776 | Female Urogenital Diseases |
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Quasi-experimental design
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Corresponds to the patient's arterial blood pH figure at the time of observation
| 6 hours |
| Arterial bicarbonate | It is the bicarbonate figure found in arterial blood. It is measured in mmol / l. | 6 hours |
| Post-filter ionic calcium | Corresponds to the value of ionic calcium by taking the sample at the blood outlet of the dialysis filter. It is measured in mmol / l. | 6 hours |
| Ionic Calcium Patien | It is the ionic calcium value of the patient in a systemic way, preferably arterial. It is measured in mmol / l | 6 hours |
| Total calcium | Total calcium value. It is measured in mmol / l | 6 hours |
| Total Ca / Ionic Ca Ratio | Relationship between the total calcium and the ionic one of the patient | 24 hours |
| Match | Value of this ion in the patient. It is measured in mmol / l. | 24 hours |
| Magnesium | Value of this ion in the patient. It is measured in mmol / l. | 24 hours |
| Sodium | Value of this ion in the patient. It is measured in mmol / l. | 24 hours |
| Potassium | Value of this ion in the patient. It is measured in mmol / l. | 24 hours |
| Urea | Urea level of the patient at the time of observation | 24 hours |
| Creatinine | Creatinine level of the patient at the time of observation | 24 hours |
| INR | INR level of the patient at the time of observation | 24 hours |
| Lactate | Lactate level of the patient at the time of observation | 24 hours |
| D005261 |
| Female Urogenital Diseases and Pregnancy Complications |
| D000091642 | Urogenital Diseases |
| D052801 | Male Urogenital Diseases |