Quality indicators in prolonged hemodialysis with regional citrate anticoagulation with the genius system: retrospective cohort of critical patients with acute kidney injury.

Background: Prolonged hemodialysis (HD) is performed from 6 to 12 h and can last up to 24 h. To prevent system clotting some studies suggest that Regional Citrate Anticoagulation (RCA) use reduces bleeding rates relative to systemic heparin. However, there may be difficulties in the patient's clinical management and completing the prescribed HD with Genius system using RCA. Objective: To analyze safety Quality Indicators (IQs) and follow up on prolonged HD with 4% sodium citrate solution in a Genius® hybrid system. Methods: This is a retrospective cohort conducted in an intensive care unit. Results: 53 random sessions of prolonged HD with 4% sodium citrate solution of critically ill patients with AKI assessed. Evaluated safety indicators were dysnatremia and metabolic alkalosis, observed in 15% and 9.4% of the sessions, respectively. Indicators of effectiveness were system clotting which occurred in 17.3%, and the minimum completion of the prescribed HD time, which was 75.5%. Conclusion: The assessment of the indicators showed that the use of RCA with a 4% sodium citrate solution in prolonged HD with the Genius system in critically ill patients with AKI can be performed in a simple, safe, and effective way. Key learning points: What is already known about the subject?: Studies on RCA or systemic heparin usage do not demonstrate differences in the mortality of critically ill patients with AKI undergoing acute RRT. However, they suggest lower bleeding rates and greater longevity of the dialysis filter. Nonetheless, hemodynamic stability and hydroelectrolytic and acid-base disorders of patients is the controversial point. What this study adds?: Quality Indicators show that this simplified prescription and RCA in prolonged HD, using the Genius® hybrid system, in critically ill patients with AKI is safe and effective. What impact this may have on practice or policy?: The proposed prescription is easy to implement, has low demands on the care team, and enables the use of hypertonic citrate for prolonged hemodialysis using the Genius® system, even with dialysate containing calcium. Monitoring the IQs may help improve the safety and effectiveness of the care routine. [ABSTRACT FROM AUTHOR]