A Clinical Study of an Automated Regional Citrate Anticoagulation Protocol in Patients with Severe Renal Failure

Abstract

Regional citrate anticoagulation (RCA) in sustained, low-efficiency, dialysis (SLED), has been found to be a more safe and effective alternative to hemodialysis. The Division of Nephrology and Hypertension at Henry Ford Hospital Main Campus has derived protocols for the automated delivery of calcium in RCA-SLED from computer models. A clinical study of these protocols has been carried out to evaluate the safety, efficacy, and efficiency of the RCA-SLED protocol in 48 patients displaying acute kidney injury (AKI) or chronic kidney disease (CKD). Safety was evaluated by analyzing maintenance of critically important systemic concentrations of hemoglobin and ionized calcium. Effectiveness of RCA-SLED was evaluated by analyzing pre- and post-treatment levels of urea clearance. Efficiency was evaluated by analyzing the performance of t.he dialyzer during this clinical study. The results conclude that RCA-SLED is a safe, effective, and efficient means of renal replacement therapy (RRT) and automation is feasible. Auto'mation, however, would not be capable without the use of complex, multivariable computer models.