Calcium-containing versus calcium-free replacement solution in regional citrate anticoagulation for continuous renal replacement therapy: a randomized controlled trial.
Study Goal
The researchers aimed to compare the safety and efficacy of calcium-containing versus calcium-free replacement solutions in continuous renal replacement therapy (CRRT) with regional citrate anticoagulation (RCA).
Results Summary
The study found no significant differences in circuit lifespan, hospital mortality, or kidney function recovery rates between the calcium-containing and calcium-free groups. Serum calcium concentrations varied slightly between groups, but citrate accumulation was rare and comparable in both.
Population
64 patients receiving RCA-based postdilution continuous venovenous hemodiafiltration (CVVHDF) at West China Hospital of Sichuan University (2017-2019).
Effective Dosage
4% trisodium citrate solution infusion (mean ~170 mL/h in both groups).
Duration
Not explicitly stated, but circuit lifespans averaged ~55-58 hours.
Interactions
None mentioned.
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
calcium-containing replacement solution | no change | circuit lifespan | patients receiving RCA-based postdilution continuous venovenous hemodiafiltration (CVVHDF) | 58.1 h (95% CI 53.8-62.4 h) vs. 55.3 h (95% CI 49.7-60.9 h, log rank P = 0.89) | had a similar circuit lifespan | #1 |
calcium-containing replacement solution | decrease | serum tCa and iCa concentrations | patients during CRRT | - | were slightly lower | #2 |
calcium-free replacement solution | decrease | postfilter iCa concentration | patients during CRRT | - | was lower | #3 |
4% trisodium citrate solution | no change | mean amounts of infusion | patients in calcium-containing vs. calcium-free groups | 171.1 ± 15.9 mL/h vs. 169.0 ± 15.1 mL/h, P = 0.49 | were not significantly different | #4 |
calcium-containing replacement solution | no change | mortality | patients during hospitalization | 14/35 [40%] vs. 13/29 [45%], P = 0.70 | were comparable | #5 |
calcium-containing replacement solution | no change | kidney function recovery rates | AKI patients during hospitalization | 19/26, 73% vs. 14/24, 58%, P = 0.27 | were comparable | #6 |
calcium-containing replacement solution | no change | hospital mortality | patients | - | had a similar | #7 |
calcium-containing replacement solution | no change | kidney outcome | patients | - | had a similar | #8 |
BACKGROUND: A simplified protocol for regional citrate anticoagulation (RCA) using a commercial calcium-containing replacement solution, without continuous calcium infusion, is more efficient for use in continuous renal replacement therapy (CRRT). We aim to design a randomized clinical trial to compare the safety and efficacy between calcium-free and calcium-containing replacement solutions in CRRT with RCA. METHODS: Of the 64 patients receiving RCA-based postdilution continuous venovenous hemodiafiltration (CVVHDF) enrolled from 2017 to 2019 in West China Hospital of Sichuan University, 35 patients were randomized to the calcium-containing group and 29 to the calcium-free replacement solution group. The primary endpoint was circuit lifespan and Kaplan-Meier survival analysis was performed. Secondary endpoints included hospital mortality, kidney function recovery rate, and complications. The amount of 4% trisodium citrate solution infusion was recorded. Serum and effluent total (tCa) and ionized (iCa) calcium concentrations were measured during CVVHDF. RESULTS: A total of 149 circuits (82 in the calcium-containing group and 67 in the calcium-free group) and 7609 circuit hours (4335 h vs. 3274 h) were included. The mean circuit lifespan was 58.1 h (95% CI 53.8-62.4 h) in the calcium-containing group vs. 55.3 h (95% CI 49.7-60.9 h, log rank P = 0.89) in the calcium-free group. The serum tCa and iCa concentrations were slightly lower in the calcium-containing group during CRRT, whereas the postfilter iCa concentration was lower in the calcium-free group. Moreover, the mean amounts of 4% trisodium citrate solution infusion were not significantly different between the groups (171.1 ± 15.9 mL/h vs. 169.0 ± 15.1 mL/h, P = 0.49). The mortality (14/35 [40%] vs. 13/29 [45%], P = 0.70) and kidney function recovery rates of AKI patients (19/26, 73% vs. 14/24, 58%, P = 0.27) were comparable between the calcium-containing and calcium-free group during hospitalization, respectively. Six (three in each group) patients showed signs of citrate accumulation in this study. CONCLUSIONS: When compared with calcium-free replacement solution, RCA-based CVVHDF with calcium-containing replacement solution had a similar circuit lifespan, hospital mortality and kidney outcome. Since the calcium-containing solution obviates the need for a separate venous catheter and a large dose of intravenous calcium solution preparation for continuous calcium supplementation, it is more convenient to be applied in RCA-CRRT practice. REGISTRATION: Chinese Clinical Trial Registry (www.chictr.org.cn, ChiCTR-IPR-17012629).