Introduction: We conducted an 8-month prospective single-center observational study in patients with acute kidney injury treated with continuous veno-venous hemofiltration (CVVH) to compare the impact of two citrate formulations on filter lifespan (FLS). Methods: Patients received CVVH at a delivered dose of 25 ml/kg/h. Multivariable linear regression was performed to assess the influence of different variables on circuit lifespan. Results: We included 59 patients, 28 received the 10/2 formulation and 31 received the 18/0 formulation. Median (interquartile range) FLS was significantly prolonged with the 18/0 solution compared with the 10/2 solution (4.10 (2.45-5.75) vs. 2.68 (0.47-4.99) days, p = 0.001). No confounding variables (difference in ionized calcium target, citrate flow or dose, platelet count, hematocrit, vascular access location) affecting filter capacity or lifespan between the 2 formulations were identified. Conclusions: Under similar conditions of CVVH and calcium targets, a Prismocitrate 18/0 formulation significantly improved FLS as compared with Prismocitrate 10/2.

Ronco C, Zanella M, et al: Management of severe acute renal failure in critically ill patients: an international survey in 345 centers. Nephrol Dial Transplant 2001;16:230-237.
Baldwin I, Tan HK, Bridge N, Bellomo R: Possible strategies to prolong circuit life during hemofiltration: three controlled studies. Ren Fail 2002;24:839-848.
Honoré PM, Lozana A: Evaluation of the pre-dilution technique in reducing the incidence of early clothing during continuous veno-venous hemofiltration in critically ill patients. Blood Purif 1997;15:121-122.
Uchino S, Fealy N, Baldwin I, Morimatsu H, Bellomo R: Pre-dilution vs. post-dilution during continuous veno-venous hemofiltration: impact on filter life and azotemic control. Nephron Clin Pract 2003;94:c94-c98.
Nurmohamed SA, Jallah BP, Vervloet MG, Beishuizen A, Groeneveld AB: Predilution versus postdilution continuous venovenous hemofiltration: no effect on filter life and azotemic control in critically ill patients on heparin. ASAIO J 2011;57:48-52.
Lafargue M, Joannes-Boyau O, Honoré PM, Gauche B, Grand H, Fleureau C, Rozé H, Janvier G: Acquired deficit of antithrombin and role of supplementation in septic patients during continuous veno-venous hemofiltration. ASAIO J 2008;54:124-128.
Shulman RI, Singer M, Rock J: Continuous renal replacement therapy. Keeping the circuit open: lessons from the lab. Blood Purif 2002;20:275-281.
Silvester W, Honoré PM, Sieffert E, Valentine J, Waggle S, Smithies MN, Bihari DJ: Effects of heparin, prostacyclin or combination, and effects of polyacrylonitrile or polysulphone membranes on filter survival in critically ill patients on continuous veno-venous hemofiltration. Blood Purif 1997;15:124-125.
Kozek-Langenecker SA, Spiss CK, Gamsjäger T, Domenig C, Zimpfer M: Anticoagulation with prostaglandins and unfractionated heparin during continuous venovenous haemofiltration: a randomized controlled trial. Wien Klin Wochenschr 2002;114:96-101.
Kozek-Langenecker SA, Kettner SC, Oismueller C, Gonano C, Speiser W, Zimpfer M: Anticoagulation with prostaglandin E1 and unfractionated heparin during continuous venovenous hemofiltration. Crit Care Med 1998;26:1208-1212.
Mehta RL, McDonald BR, Aguilar MM, Ward DM: Regional citrate anticoagulation for continuous arteriovenous hemodialysis in critically ill patients. Kidney Int 1990;38:976-981.
Lameire N, Kellum JA; KDIGO AKI Guideline Work Group: Contrast-induced acute kidney injury and renal support for acute kidney injury: a KDIGO summary (part 2). Crit Care 2013;17:205.
Hofbauer R, Moser D, Frass M, Oberbauer R, Kaye AD, Wagner O, Kapiotis S, Druml W: Effect of anticoagulation on blood membrane interactions during hemodialysis. Kidney Int 1999;56:1578-1583.
Flanigan MJ, Pillsbury L, Sadewasser G, Lim VS: Regional hemodialysis anticoagulation: hypertonic tri-sodium citrate or anticoagulant citrate dextrose-A. Am J Kidney Dis 1996;27:519-524.
Oudemans-van Straaten HM, Bosman RJ, Koopmans M, van der Voort PH, Wester JP, van der Spoel JI, Dijksman LM, Zandstra DF: Citrate anticoagulation for continuous venovenous hemofiltration. Crit Care Med 2009;37:545-552.
Egi M, Naka T, Bellomo R, Cole L, French C, Trethewy C, Wan L, Langenberg CC, Fealy N, Baldwin I: A comparison of two citrate anticoagulation regimens for continuous veno-venous hemofiltration. Int J Artif Organs 2005;28:1211-1218.
Tolwani AJ, Prendergast MB, Speer RR, Stofan BS, Wille KM: A practical citrate anticoagulation continuous venovenous hemodiafiltration protocol for metabolic control and high solute clearance. Clin J Am Soc Nephrol 2006;1:79-87.
Honoré PM, Jacobs R, De Regt J, de Mars M, Spapen HS: Citrate during CRRT; in Vuylsteke A (ed): Renal Replacement Therapy - Core Critical Care. Cambridge University Press, 2015.
Leung AK, Shum HP, Chan KC, Chan SC, Lai KY, Yan WW: A retrospective review of the use of regional citrate anticoagulation in continuous venovenous hemofiltration for critically ill patients. Crit Care Res Pract 2013;2013:349512.
Joannidis M, Oudemans-van Straaten HM: Clinical review: patency of the circuit in continuous renal replacement therapy. Crit Care 2007;11:218.
Oudemans-van Straaten HM, Wester JP, de Pont AC, Schetz MR: Anticoagulation strategies in continuous renal replacement therapy: can the choice be evidence based? Intensive Care Med 2006;32:188-202.
Oudemans-van Straaten HM, Kellum JA, Bellomo R: Clinical review: anticoagulation for continuous renal replacement therapy - heparin or citrate? Crit Care 2011;15:202.
Oudemans-van Straaten HM, Ostermann M: Bench-to-bedside review: citrate for continuous renal replacement therapy, from science to practice. Crit Care 2012;16:249.
Treschan TA, Schaefer MS, Geib J, Bahlmann A, Brezina T, Werner P, Golla E, Greinacher A, Pannen B, Kindgen-Milles D, Kienbaum P, Beiderlinden M: Argatroban versus Lepirudin in critically ill patients (ALicia): a randomized controlled trial. Crit Care 2014;18:588.
Vaussenat F, Bosc JY, LeBlanc M, Canaud B: Data acquisition system for dialysis machines. A model for membrane hydraulic permeability. ASAIO J 1997;43:910-915.
Tolwani AJ, Wille KM: Anticoagulation for continuous renal replacement therapy. Semin Dial 2009;22:141-145.
Gritters M, Grooteman MP, Schoorl M, Schoorl M, Bartels PC, Scheffer PG, Teerlink T, Schalkwijk CG, Spreeuwenberg M, Nubé MJ: Citrate anticoagulation abolishes degranulation of polymorphonuclear cells and platelets and reduces oxidative stress during haemodialysis. Nephrol Dial Transplant 2006;21:153-159.
Kramer L, Bauer E, Joukhadar C, Strobl W, Gendo A, Madl C, Gangl A: Citrate pharmacokinetics and metabolism in cirrhotic and noncirrhotic critically ill patients. Crit Care Med 2003;31:2450-2455.
Mulder J, Tan HK, Bellomo R, Silvester W: Platelet loss across the hemofilter during continuous hemofiltration. Int J Artif Organs 2003;26:906-912.
Davies H, Leslie G: Maintaining the CRRT circuit: non-anticoagulant alternatives. Aust Crit Care 2006;19:133-138.
Honore PM, Joannes-Boyau O, Collin V, Boer W, Gressens B, Janvier G: Practical daily management of extrarenal continuous removal. Reanimation 2008;17:472-477.
del Castillo J, López-Herce J, Cidoncha E, Urbano J, Mencía S, Santiago MJ, Bellón JM: Circuit life span in critically ill children on continuous renal replacement treatment: a prospective observational evaluation study. Crit Care 2008;12:R93.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.