[Regional citrate anticoagulation for continuous renal replacement therapy]. / Anticoagulation régionale au citrate pour l'épuration extrarénale continue.

Regional citrate anticoagulation (RCA) is currently the recommended anticoagulation modality for continuous renal replacement therapy. Indeed, compared with systemic heparinization, RCA is associated with a lower risk of bleeding, a longer circuit lifespan and a decrease nursing workload. However, RCA requires a strict protocol to be followed, as it might be associated with potentially severe complications, such as citrate accumulation. Citrate accumulation is rare and usually associated with specific situations : severe circulatory shock, liver failure and mitochondrial dysfunction. According to centers' expertise, these situations might represent contra-indications to RCA. This review presents RCA, its mode of action, associated risks and proposes an algorithm for patients' selection.

L'anticoagulation régionale au citrate (ARC) est actuellement la modalité de choix pour l'épuration extrarénale continue. Par rapport à une anticoagulation systémique par héparine, l'ARC est associée à un moindre risque hémorragique, une plus longue durée de vie des circuits et une moindre charge de travail infirmière. Cependant, elle nécessite de mettre en place un protocole strict, car elle peut être associée à des complications potentiellement graves dont la plus redoutée est l'intoxication au citrate. Cette dernière est rare et ne survient a priori que lors de certaines situations à risque : état de choc sévère, insuffisance hépatique ou dysfonction mitochondriale. En fonction de l'expertise des centres, ces situations peuvent représenter des contre-indications à l'ARC. Cet article présente l'ARC, son mode d'action, les risques associés et propose un algorithme de sélection des patients.

A First Evaluation of OMNI®, A New Device for Continuous Renal Replacement Therapy.

BACKGROUND: Omni® (B. Braun, Germany) is a new-generation, continuous renal replacement therapy (CRRT) machine designed to improve user interface, minimize downtime and optimize renal dose delivery. It was never tested in humans. METHODS: We used Omni® to provide CRRT in 10 critically ill patients. We collected therapy data, metabolic parameters and evaluated user's satisfaction with a survey. RESULTS: CRRT was delivered using Omni® in CVVH-heparin (6 patients) and CVVHD-citrate (4 patients) modes for a total duration of 617.7 h. No adverse event was observed. The mean filter life was 22.8 (CVVH-heparin) and 33.5 (CVVHD-citrate) h. Alarms-related downtime corresponded to 5.9% of total therapy time. Delivered renal dose was 96.6% of prescribed. Satisfactory metabolic control and fluid removal were achieved. Overall, users evaluated interface, design and usability as excellent. CONCLUSION: CRRT in CVVH-heparin and CVVHD-citrate modes was provided using Omni® in a safe and efficient way for 10 critically ill patients. Video Journal Club 'Cappuccino with Claudio Ronco' at http://www.karger.com/?doi=451053.