Table 2.

Comparison of CVVHDF protocols using regional citrate anticoagulationa

Author, YearPatientBFR (ml/min)Citrate Solution (mM/L)Citrate RateReplacement Solution (mM/L)Replacement Solution Flow RateDialysate Composition (mM/L)D RateCa Solution (mM of Elemental Ca/L)Ca RateCircuit Survival Time 48 hNo. of CRRT Solutions
Mehta et al., 1990 (10)18100TSC+ 4% Citrate 140Na 408140 to 220 ml/h (19.6 to 30.8 mM/h)Prefilter: NS 0.9%Postfilter: NS 0.9% and VariablePrefilter: 500 ml/hPostfilter: 0.2 to 1.5 L/hNa 117Cl 81 to 121 K 0 to 4Mg 1Dextrose 0.1%HCO3 0 to 401 L/hCaCl 0.8%40 to 60 ml/h68%5
Kutsogiannis et al., 2000 (9)9100 to 125TSC 4%Citrate 140Na 408140 to 190 ml/h (19.6 to 26.6 mM/h)Prefilter:Na 150.3Cl 121HCO3 33.3K 3 to 4Mg 0.7Prefilter 1 to 1.5 L/hNa 117Cl 121.5K 3 to 4Mg 0.71 to 1.5 L/hCaCl 0.75%40 to 60 ml/h68%4
Gabutti et al., 2002 (6)12150Citrate 13.3Na 139.9Mg 0.75 (K as needed)1.5 L/h (23 mM/h)See citrate solutionSee citrate solutionCitrate 13.3Na 139.9Mg 0.75 (K as needed)500 ml/h5% CaCl or 350 mM/LMean rate: 10 ml/h or 3.31 mM/h15%3
Dorval et al., 2003 (7)14125Hemocitrasol-20Na 145Citrate 20Glucose 10(K and PO4 as needed)1.25 L/h (25 mM/h)See citrate solutionSee citrate solution(Dialysate added in only 27% patients)NS 0.9%Na 1541 L/h as neededMg 16 mM/L and 1% CaCl 70 mM/L50 ml/h or 3.5 mM/h50%3
Tobe et al., 2003 (8)15100ACD-ACitrate 113Na 224150 ml/h(17 mM/h)Prefilter:NS 0.9% or 0.5 NS0 to 1 L (started for HCO3 > 25)Normocarb®Na 140HCO3 35Cl 106.5Mg 0.75(K as needed)1 to 1.5 L/hCaCl 4 g in 1 L of D5W50 ml/happrox. 50%4
Cointault et al., 2004 (5)17125ACD-ACitrate 113Na 224250 ml/h (30 mM/h)Prefilter: Hemosol and Hemosol with BicarbonateNa 144HCO3 35Lactate 3Mg 0.5Calcium 1.75 (mixture of two solutions)1.2 L/hHemosol and Hemosol with BicarbonateNa 144HCO3 35Lactate 3Mg 0.5 Ca 1.75 (mixture of solutions are varied to adjust bicarbonate)1.2 L/hCaCl 45.6 mM/L30 ml/h or 1.37 mM/h41%4
Tolwani et al., 2005 (15)32100 to 150TSC 0.5%Citrate 18Na 1401 to 1.5 L/h (18 to 27 mM/h)See citrate solutionSee citrate solutionNa 140K 4HCO3 25Mg 0.58 (similar solution commercially available)1 to 2 L/hCa gluconate 38.75 mM/L60 ml/h or 2.3 mM/h82%3
  • a BFR, blood flow rate; D, dialysate; TSC+, trisodium citrate; ACD-A, anticoagulant citrate dextrose solution, Formula A.