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Introduction: Omni® (B Braun, Melsungen, Germany) is able to run continuous renal replacement therapy (CRRT) in continuous veno-venous hemofiltration (CVVH), hemodialysis (CVVHD), and hemodiafiltration (CVVHDF) modes. However, to date, there is no validated protocol to guide the use of Omni® in CVVHDF mode with regional citrate anticoagulation (RCA). Methods: We designed a protocol for CVVHDF-RCA tailored for Omni®. This protocol was tested in patients included in an observational study conducted in our center between January and March 2021. For all study patients, we collected baseline characteristics, laboratory results, CRRT circuit lifespan as well as plasma and effluent samples at 12, 24, 48, and 72 h of CRRT circuit initiation. At each study time point, we computed urea, creatinine, and β2-microglobulin clearance as well as effluent/blood ratios. Data from circuits in CVVHDF-RCA mode are compared with those in standard therapy (CVVHD-RCA) with the same device. Results: We analyzed ten circuits (5 patients) in CVVHDF-RCA mode and 32 (13 patients) in CVVHD-RCA mode. No adverse events related to the therapy were observed. In CVVHDF-RCA mode, median circuit running time was 68 (IQR 8.1) hours versus 46 (IQR 9.0) in CVVHD mode, p = 0.053. Therapy adaptations (dialysate rate and/or blood flow) were required in one (10%) circuit (15.6% in CVVHD mode, p = 0.56). Compared to CVVHD, CVVHDF was able to achieve similar clearance and effluent/blood ratio for urea, creatinine, and β2-microglobulin across the entire duration of circuit lifetime. Conclusion: The proposed protocol for CVVHDF-RCA for Omni® was associated with similar circuit lifetime, number of required adaptations and clearances to standard CVVHD-RCA. It appears to be safe and feasible. [ABSTRACT FROM AUTHOR]

Background: Peri-operative coagulation management of patients receiving apixaban, a new oral anticoagulant, is difficult. The CytoSorb® hemoadsorption device might represent a therapeutic option to reduce apixaban's pharmacological and inflammatory effects during high-risk surgery. Case presentation: An 83-year-old woman treated with Apixaban underwent emergent redo mitral valve replacement for prosthetic valve endocarditis. A CytoSorb® cartridge was added to the cardio-pulmonary bypass (CPB) circuit. Apixaban-specific anti-factor Xa activity (AFXaA) were measured peri-operatively. After 100 minutes of CPB, a 50% AFXaA rate decrease was observed as compared to pre-CPB values. Furthermore, we noticed 39% and 44% reductions of AFXaA levels in comparison to the expected levels in patients with normal or altered renal function, respectively. Conclusion: Insertion of a CytoSorb® cartridge in the CPB was safe and associated with rapid correction of Apixaban-associated anticoagulation. [ABSTRACT FROM AUTHOR]