New Citrate Protocol With Baxter in Continuous Techniques

Study Overview
=================
Brief Summary
-----------------
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.

Detailed Description
-----------------
Study design: Observational Registration of variables for analysis. 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 10 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.

Official Title
-----------------
Validation of the Protocol for the Use of Regional Anticoagulation With Baxter Citrate in Continuous Extrarenal Purification Techniques in the Critical Patient

Conditions
-----------------
Renal Insufficiency, Acute

Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Adult patients (regardless of their underlying pathology), who develop acute renal failure, admitted to the ICU of St Pau with the medical team of Intensive Medicine, who require anticoagulation with citrate in continuous dialysis therapy and are treated with the Baxter monitor. Exclusion Criteria: Those patients who do not meet the above requirement
Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------
What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | 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 | 

Secondary Outcome Measures

| Outcome Measure | 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 | 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 | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
citrate anticoagulation, calcemia control