• Dmytro Khadzhynov, Jonas Deissler, Otajon Bobonov, Christin Schelter, Harm Peters, Detlef Kindgen-Milles, Klemens Budde, Lukas Johannes Lehner, Fabian Halleck, Oliver Staeck, Kai-Uwe Eckardt, and Torsten Slowinski.
• Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Charitéplatz 1, 10117 Berlin, Germany. Electronic address: Dmytro.Khadzhynov@charite.de.
• J Crit Care. 2020 Aug 1; 58: 1-5.

BackgroundThe aim of the present study was to assess the predictive value of post-filter ionized calcium (pfCa) levels for filter-clotting during continuous veno-venous hemodialysis (CVVHD) with regional citrate anticoagulation (RCA).MethodsRetrospective analysis of a database derived from 6 intensive care units (ICU) at a university hospital. During the 3-year period 1070 patients were treated with RCA-CVVHD with a citrate starting dose of 4 mmol/L blood and a target-range for pfCa of 0.25-0.35 mmol/L.ResultsThe pfCa concentrations at RCA-CVVHD initiation were within the target range in 69.7% of patients. Within 12 h the fraction of patients with pfCa above target-range decreased significantly from 13.1% to 7.8% (p < .001). There was no significant difference in filter survival between patients with a pfCa initially below, within, or above the target-range (83.7%, 89.5% and 90.4%; p = .228) and no significant correlation between the last pfCa and the incidence of filter clotting (rho 0.018, p = .572 and -0.054, p = .104; respectively).ConclusionsCVVHD with a citrate starting dose of 4 mmol/L blood resulted in a pfCa within target in the majority of patients. The observation that pfCa was not associated with the incidence of circuit clotting suggests that less frequent measurements of pfCA might be safe.Copyright © 2020 Elsevier Inc. All rights reserved.

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