Résumé
Background: using calcium free citrate continent dialysate to regionale anticoagulated renal replacement therapy circuit is a new and risky approach. Regional hypocalcemia induced in extracorporeal circulation must be reversed to avoid systemic complications. Our study assessed the safety and efficacy of a local simple chloride calcium reinjection protocol. Method and design: retrospective descriptive monocentric study in a trauma and polyvalent critical care unit between January 2019 and July 2021 of patient undergoing Intermittent dialysis using citrate enriched dialysate without calcium (CITRASATE 484®). Ionized calcemia (iCa) and chloride calcium flow reinjection (CaCl2) was recorded at beginning (T0), in the first two hours (T1), others control if required and at the end (Tend). Calcium stability was assessed using difference between iCa-T0 and iCa-T1(∆iCaT0-T1) and iCa-T0 and iCa-T1(∆iCaT0-TEnd). We defined slightand significant modification in CaCl2 by ≤0.5 g/L and >0.5 g/L, respectively. Specific complications and dialysis doses were secondary studied. Results: of 40 studied patients, 220 dialysis sessions were assessed. ∆iCaT0-T1 and ∆iCaT0-Tend was -0.07mmol/L (IQR, -0.13‒0.00) and -0.01 mmol/L (IQR -0.12‒0.07 mmol/L) respectively. iCa-End was 1.15 mmol/L (IQR, 1.07‒1,30 mmol/L.) CaCl2-T1 required no change for 68% of sessions, a slight modification for 20%, and a significant modification for 7%. Only 2 sessions required a CaCl2 reinjection suspension and 4 sessions required acalcium chloride bolus. Significant hypocalcemia and hypercalcemia occurred in 5 and 9 sessions respectively, while 7 sessions required norepinephrine introductionand 29 sessions experienced a premature clotting. KtV was 1.3 (IQR 1.1–1.6) and urea reduction ratio was 65% (IQR 54%-75%). Conclusions: intermittent dialysis using citrate enriched dialysate without calcium and chloride calcium reinjection protocol is safe, reliable and simple to applied.