Objective: To evaluate the effectiveness of continuous arteriovenous hemodiafiltration (CAVHD) using citrate as the anticoagulant for the treatment of lactic acidosis in patients with renal failure.
Design: Case series with careful monitoring of the clinical course of patients being treated in a medical or surgical ICU.
Setting: University hospital ICU.
Patients: Two patients with lactic acidosis are described, along with our experience using CAVHD and citrate in other clinical settings.
Interventions: CAVHD was used to manage renal failure, while a continuous infusion of citrate was administered to maintain patency of the extracorporeal circuit.
Measurements: Total and ionized serum calcium concentrations and citrate concentrations were monitored.
Main results: CAVHD with citrate as the anticoagulant proved to be a convenient means of managing vascular volume, serum electrolyte concentrations, acid-base balance, and replacement renal function requirements in the setting of severe lactic acidosis, oliguric renal failure, and hemorrhagic diathesis.
Conclusions: CAVHD with citrate as the anticoagulant can be recommended as effective therapy for selected patients, but careful monitoring is needed to avoid serious complications.