Effects of Different Continuous Renal Replacement Therapy Patterns on Ionized Calcium in Patients With Citrate Anticoagulants Using Calcium-containing Replacement Solutions

Study Overview
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Brief Summary
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It is unclear whether different modes of continuous renal replacement therapy (CRRT) impact post-filter ionized calcium concentrations during regional citrate anticoagulation (RCA) when using calcium-containing replacement fluid. This prospective, single-center, observational cohort study will screen all patients receiving CRRT for eligibility. General clinical information will be collected before commencing CRRT treatment. Patients will be randomly assigned to either the veno-venous hemofiltration (CVVH) or continuous veno-venous hemodialysis (CVVHD) group and switch to the alternative mode in the subsequent treatment session. Pre-filter and post-filter ionized calcium, systemic total and ionized calcium, and effluent total and ionized calcium will be measured 2 hours after the initiation of CRRT. Electrolyte levels, arterial blood gases, hourly citrate dose, and total citrate dose will be recorded every 6 hours until the end of CRRT. The primary outcome is the difference in ionized calcium concentrations at each site over time between the two modes.

Official Title
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Effects of Different Continuous Renal Replacement Therapy Patterns on Ionized Calcium in Patients With Citrate Anticoagulants Using Calcium-containing Replacement Solutions

Conditions
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Renal Injury, Regional Citrate Anticoagulation, Continuous Renal Replacement Therapy

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age ≥ 18 years old; Receiving citrate anticoagulation; Obtain Informed consent from patients or next of kin. Exclusion Criteria: Pregnant or lactating women; Allergic to citrate anticoagulants; Severe liver dysfunction (total bilirubin levels exceeding two times the normal range); Hypoxemia (PaO2 < 60 mmHg); Inadequate tissue perfusion (blood pressure < 90/60 mmHg despite high doses of vasoactive agents); Hyperlactatemia (lactate> 4 mmol/L); Hypernatremia; Estimated length of hospital stay < 48h; Participated in other studies.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 100 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| CVVHD<br>Continuous Veno-Venous Hemosdialysis | |
| CVVH<br>Continuous Veno-Venous Hemofiltration | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Post-filter iCa | The post-filter ionized calcium concentration | 2 hours after the initiation of CRRT | 
| Serum iCa | Serum ionized calcium concentration | 2 hours after the initiation of CRRT | 
| Serum Ca2+ | Serum total calcium concentration | 2 hours after the initiation of CRRT | 
| Effluent Ca2+ | Effluent total calcium concentration | 2 hours after the initiation of CRRT | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Incidence of new-onset metabolic complications | Including hypercalcemia, hypocalcemia, metabolic acidosis, metabolic alkalosis, citrate accumulation, hypernatremia, and hyponatremia | 48 hours after the initiation of CRRT | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Renal Injury, Regional citrate anticoagulation, Continuous renal replacement therapy