Regional citrate anticoagulation in critically ill patients treated with plasma filtration and adsorption

Blood Purif. 2004;22(3):313-9. doi: 10.1159/000078788.


Background: In high-risk bleeding conditions conventional systemic anticoagulation with heparin is a contraindication to renal replacement therapy. We evaluate the feasibility and safety of regional citrate anticoagulation in high-risk bleeding conditions during coupled plasma filtration adsorption (CPFA).

Methods: Thirteen critically ill patients (9 severely burned, 4 polytraumas) with septic shock and acute renal failure treated with CPFA-CVVHD by using bicarbonate-based solutions (heparin-CPFA group, 58 sessions) or with CPFA-CVVHF using citrate (citrate-CPFA group, 36 sessions).

Results: Plasma flow and used cartridges showed no differences between the citrate-CPFA and heparin-CPFA groups, while lost clotted cartridges were significantly lower in the citrate-CPFA group. Blood ionized calcium (iCa2+), Ca2+ infusion, pH and bicarbonates remained constant during citrate-CPFA, with no difference between pre- and post-cartridge plasma citrate. A significant positive correlation between iCa2+ in blood and ultrafiltrate was present.

Conclusions: These suits demonstrate the feasibility and safety of regional citrate anticoagulation in severely burned and polytrauma septic patients treated by CPFA.

Publication types

  • Clinical Trial

MeSH terms

  • Acute Kidney Injury / etiology
  • Acute Kidney Injury / microbiology
  • Acute Kidney Injury / therapy
  • Adult
  • Aged
  • Anticoagulants / therapeutic use*
  • Burns / complications
  • Burns / therapy
  • Calcium / blood
  • Chemotherapy, Cancer, Regional Perfusion
  • Citric Acid / administration & dosage*
  • Citric Acid / blood
  • Contraindications
  • Critical Illness
  • Dialysis Solutions
  • Female
  • Hemofiltration*
  • Hemorrhage / prevention & control
  • Heparin / administration & dosage
  • Humans
  • Male
  • Middle Aged
  • Multiple Trauma / complications
  • Multiple Trauma / therapy
  • Shock, Septic / complications
  • Sorption Detoxification
  • Treatment Outcome


  • Anticoagulants
  • Dialysis Solutions
  • Citric Acid
  • Heparin
  • Calcium