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

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

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?

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)