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Calcium priming of the central venous catheter prevents a drop in ionized calcium concentration during Regional Citrate Anticoagulation

Roveri, Giulia*; Busana, Mattia; Lusardi, Andrea Clarissa*; Ferrari, Federica*; Trevisan, Giacomo*; Di Girolamo, Luca*; Dei Poli, Marco; Resta, Marco Vittorio

doi: 10.1097/MAT.0000000000000911
Renal/Extracorporeal Blood Treatment

During citrate-based Continuous Renal Replacement Therapy (CRRT), an infusion of calcium is necessary to replace the calcium lost in the effluent. The replacement takes place through a central venous catheter (CVC) that is primed with saline solution. Thus, we hypothesized a potential systemic anticoagulation caused by the unchelated citrate reaching the patient at the start of CRRT because of 0.42 ml of line dead space. In this pilot study, two subpopulations of 7 patients who underwent Continuous Veno-Venous Hemodiafiltration (150 ml/min of blood flow, 1500 ml/h dialysate flow, 1500 ml/h of citrate predilution) were studied. One had the CVC primed with saline, the second with calcium chloride 10%. Calcium replacement rate was 6.3 ± 0.2 ml/h. Ionized calcium concentration was studied over time in the two groups and in the group with saline priming we detected a transient period of hypocalcemia (ionized calcium concentration [iCa] < 1.00 mmol/l for the first 2 hours). In the subpopulation with the calcium priming, this was not present. No significant effect on filter life emerged. Priming of the catheter with calcium seems effective in avoiding a potential issue regarding citrate accumulation at the start of CRRT. More studies are needed to assess the clinical significance of this finding.

From the *Department of Medical-Surgical Physiopathology and Transplants, University of Milan, Milan, Italy

Department of Anesthesiology, Emergency and Intensive Care Medicine, University of Göttingen, Robert-Koch-Straße 40, 37075 Göttingen, Germany

Department of Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese, Italy.

Submitted for consideration May 2018; accepted for publication in revised form September 2018.

Disclosure: The authors have no conflicts of interest to report.

The study was funded by Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, San Donato Milanese (MI), Italy.

Correspondence: Mattia Busana, Università degli Studi di Milano. Email:

Copyright © 2019 by the American Society for Artificial Internal Organs