biostudies-literatureRhee HNIDDK NIH HHSNIH550-559.e1https://www.ebi.ac.uk/biostudies/studies/S-EPMC8723918biostudies-literatureUnknown78(4)<h4>Objective</h4>Regional citrate anticoagulation (RCA) is the preferred anticoagulation method for continuous kidney replacement therapy (CKRT) recommended by KDIGO. Limited availability of calcium-free solutions often imposes challenges to the implementation of RCA for CKRT (RCA-CKRT). The principal purpose of this study was to characterize the outcomes of RCA-CKRT using calcium-containing solutions.<h4>Study design</h4>Retrospective cohort study.<h4>Setting & participants</h4>We evaluated the safety and efficacy of RCA-CKRT with calcium-containing dialysate and replacement fluid used for 128 patients. A total of 571 filters and 1,227 days of CKRT were analyzed.<h4>Exposures</h4>Liver disease, sepsis in the absence of liver disease, and sepsis with liver disease.<h4>Outcomes</h4>Filter life and metabolic complications per 100 CKRT days.<h4>Analytical approach</h4>Linear mixed-effects model and generalized linear mixed-effects models.<h4>Results</h4>The majority of patients were male (91; 71.1%), 32 (25%) had liver disease, and 29 (22.7%) had sepsis without liver disease. Median filter life was 50.0 (interquartile range, 22.0-118.0) hours, with a maximum of 322 hours, and was significantly lower (33.5 [interquartile range, 17.5-60.5] h) in patients with liver disease. Calcium-containing replacement solutions were used in 41.6% of all CKRT hours and reduced intravenous calcium requirements by 31.7%. Hypocalcemia (ionized calcium<0.85mmol/L) and hypercalcemia (total calcium>10.6mg/dL) were observed in 6.0 and 6.7 per 100 CKRT days, respectively. Citrate accumulation was observed in 13.3% of all patients and was associated with metabolic acidosis in 3.9%, which was not significantly different in patients with liver disease (9.3%; P = 0.2).<h4>Limitations</h4>Lack of control groups that used calcium-free dialysate and replacement solutions with RCA-CKRT. Possible overestimation of filter life from incomplete data on cause of filter failure.<h4>Conclusions</h4>Our study suggests that RCA-CKRT with calcium-containing solutions is feasible and safe in critically ill patients, including those with sepsis and liver disease.American journal of kidney diseases : the official journal of the National Kidney FoundationRegional Citrate Anticoagulation for Continuous Kidney Replacement Therapy With Calcium-Containing Solutions: A Cohort Study.PMC8723918DK079337P30 DK079337Macedo EBerenger BRhee HMehta RLfalseRegional Citrate Anticoagulation for Continuous Kidney Replacement Therapy With Calcium-Containing Solutions: A Cohort Study.<h4>Objective</h4>Regional citrate anticoagulation (RCA) is the preferred anticoagulation method for continuous kidney replacement therapy (CKRT) recommended by KDIGO. Limited availability of calcium-free solutions often imposes challenges to the implementation of RCA for CKRT (RCA-CKRT). The principal purpose of this study was to characterize the outcomes of RCA-CKRT using calcium-containing solutions.<h4>Study design</h4>Retrospective cohort study.<h4>Setting & participants</h4>We evaluated the safety and efficacy of RCA-CKRT with calcium-containing dialysate and replacement fluid used for 128 patients. A total of 571 filters and 1,227 days of CKRT were analyzed.<h4>Exposures</h4>Liver disease, sepsis in the absence of liver disease, and sepsis with liver disease.<h4>Outcomes</h4>Filter life and metabolic complications per 100 CKRT days.<h4>Analytical approach</h4>Linear mixed-effects model and generalized linear mixed-effects models.<h4>Results</h4>The majority of patients were male (91; 71.1%), 32 (25%) had liver disease, and 29 (22.7%) had sepsis without liver disease. Median filter life was 50.0 (interquartile range, 22.0-118.0) hours, with a maximum of 322 hours, and was significantly lower (33.5 [interquartile range, 17.5-60.5] h) in patients with liver disease. Calcium-containing replacement solutions were used in 41.6% of all CKRT hours and reduced intravenous calcium requirements by 31.7%. Hypocalcemia (ionized calcium<0.85mmol/L) and hypercalcemia (total calcium>10.6mg/dL) were observed in 6.0 and 6.7 per 100 CKRT days, respectively. Citrate accumulation was observed in 13.3% of all patients and was associated with metabolic acidosis in 3.9%, which was not significantly different in patients with liver disease (9.3%; P = 0.2).<h4>Limitations</h4>Lack of control groups that used calcium-free dialysate and replacement solutions with RCA-CKRT. Possible overestimation of filter life from incomplete data on cause of filter failure.<h4>Conclusions</h4>Our study suggests that RCA-CKRT with calcium-containing solutions is feasible and safe in critically ill patients, including those with sepsis and liver disease.2021-01-01T00:00:00Z2021 Oct2025-04-04T12:04:58.774Z2025-04-04T12:04:58.774ZS-EPMC87239183379863610.1053/j.ajkd.2021.01.017