Division of Nephrology and Dialysis, Department of Pediatrics, Bambino Gesù Children's Hospital and Research Institute, Piazza Sant'Onofrio 4, 00165, Rome, Italy.
Pediatric Emergency Department, Pediatric Intensive Care Unit, Bambino Gesù Children's Hospital and Research Institute, Piazza Sant'Onofrio 4, 00165, Rome, Italy.
Pediatr Nephrol. 2023 Nov;38(11):3835-3844. doi: 10.1007/s00467-023-05994-y. Epub 2023 May 24.
Regional citrate anticoagulation (RCA) is the preferred modality of anticoagulation used in continuous kidney replacement therapy (CKRT) in adults and less extensively in children. Potential metabolic complications limit widespread use in infants, neonates, and in children with liver failure.
We report our experience with a simplified protocol in 50 critically ill children, infants, and neonates, some of them with liver failure, with commercially available solutions containing phosphorous and higher concentration of potassium and magnesium.
RCA allowed attainment of a mean filter lifetime of 54.5 ± 18.2 h, 42.5% of circuits lasted more than 70 h, and scheduled change was the most frequent cause of CKRT interruption. Patient Ca and circuit Ca were maintained in the target range with mean values of 1.15 ± 0.13 mmol/l and 0.38 ± 0.07 mmol/l, respectively. No session had to be stopped because of metabolic complications. The most frequent complications were hyponatremia, hypomagnesemia, and metabolic acidosis mostly related to primary disease and critical illness. No session had to be stopped because of citrate accumulation (CA). Transitory CA occurred in 6 patients and was managed without requiring RCA interruption. No patients with liver failure presented CA episodes.
In our experience, RCA with commercially available solutions was easily applied and managed in critically ill children, even in patients with low weight or with liver failure. Solutions containing phosphate and higher concentrations of magnesium and potassium allowed reduction of metabolic derangement during CKRT. Prolonged filter life was ensured with no detrimental effects on patients and reduced staff workload. A higher resolution version of the Graphical abstract is available as Supplementary information.
区域枸橼酸抗凝（RCA）是成人连续肾脏替代治疗（CKRT）中首选的抗凝方式，在儿童中应用较少。潜在的代谢并发症限制了其在婴儿、新生儿和肝功能衰竭患儿中的广泛应用。
我们报告了在 50 例危重症儿童、婴儿和新生儿中应用简化方案的经验，其中一些患儿存在肝功能衰竭，使用的是含有磷且钾和镁浓度较高的市售制剂。
RCA 可使滤器平均寿命达到 54.5±18.2 h，42.5%的治疗回路持续时间超过 70 h，而 CKRT 中断最常见的原因是计划更换。患者和回路的 Ca 均维持在目标范围内，平均浓度分别为 1.15±0.13 mmol/l 和 0.38±0.07 mmol/l。没有因代谢并发症而停止任何治疗。最常见的并发症是低钠血症、低镁血症和代谢性酸中毒，这些大多与原发疾病和危重症有关。没有因枸橼酸盐蓄积（CA）而停止任何治疗。6 例患者出现一过性 CA，无需中断 RCA 即可得到处理。无肝功能衰竭患者发生 CA 事件。
根据我们的经验，即使是在低体重或肝功能衰竭的患儿中，使用市售制剂的 RCA 也易于实施和管理。含有磷酸盐且钾和镁浓度较高的制剂可减少 CKRT 期间的代谢紊乱。通过延长滤器寿命，确保了患者的安全，同时降低了工作人员的工作量。更清晰的图表可在补充信息中查看。
