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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
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?
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| No monitoring of post filter ionized calcium | Experimental | 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. |
|
| Monitoring of post filter ionized calcium | Placebo Comparator | 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. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Regional citrate anticoagulation | Other | Starting RCA 4 mmol/L (adjust the rate by BFR) |
|
| Measure | Description | Time Frame |
|---|---|---|
| Filter lifetime in hours | How long with filter with RCA | 72 hours |
| Measure | Description | Time Frame |
|---|---|---|
| Adverse event | adverse event of RCA | 72 hours |
| Circuit downtime in hours | Circuit downtime during CRRT with RCA | 72 hours |
| Measure | Description | Time Frame |
|---|---|---|
| Change of SOFA scores | Change of SOFA Scores (Use the worst value in 24 hour) from baseline to end of the study | 72 hours |
| Change of APACHE II score | Change of APACHE II score (Use the worst value in 24 hour)from baseline to end of the study |
Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Chulalongkorn university | Bangkok | 10330 | Thailand |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 37664560 | Derived | Thanapongsatorn P, Sinjira T, Kaewdoungtien P, Kusirisin P, Kulvichit W, Sirivongrangson P, Peerapornratana S, Lumlertgul N, Srisawat N. Standard versus no post-filter ionized calcium monitoring in regional citrate anticoagulation for continuous renal replacement therapy (NPC trial). Clin Kidney J. 2023 Mar 31;16(9):1469-1479. doi: 10.1093/ckj/sfad069. eCollection 2023 Sep. |
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Masking of post-filter ionized calcium result in no-monitoring arm
| Vasopressor | Drug | Vasopressors such as Norepinephrine, dopamine, milrinone, dobutamine |
|
| Antibiotic | Drug | Antibacterial agents deemed appropriate by physicians in the ICU |
|
| Dialysis with continuous renal replacement therapy | Device | Prismaflex |
|
| Cost per treatment in Baht | Cost of CRRT include laboratory in Baht | 72 hour |
| Citrate accumulation | Number of total calcium to ionized calcium ratio > 2.5 | 72 hours |
| Efficacy of CRRT | Seiving coefficient of urea and difference of prescribed dose of CRRT | 72 hours |
| Citrate dose | Average citrate dose | 72 hours |
| 72 hours |
| Change of Hct | Rate of Hct change from from baseline to end of the study | 72 hours |
| Change of electrolyte | Rate of electrolyte change from baseline to end of the study | 72 hours |
| ID | Term |
|---|---|
| D014662 | Vasoconstrictor Agents |
| D000900 | Anti-Bacterial Agents |
| D003956 | Dialysis |
| D000079664 | Continuous Renal Replacement Therapy |
| ID | Term |
|---|---|
| D002317 | Cardiovascular Agents |
| D045506 | Therapeutic Uses |
| D020228 | Pharmacologic Actions |
| D020164 | Chemical Actions and Uses |
| D000890 | Anti-Infective Agents |
| D002623 | Chemistry Techniques, Analytical |
| D008919 | Investigative Techniques |
| D055598 | Chemical Phenomena |
| D017582 | Renal Replacement Therapy |
| D013812 | Therapeutics |
| D005112 | Extracorporeal Circulation |
| D013514 | Surgical Procedures, Operative |
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