High risk for bleeding was arbitrarily defined as a platelet count of less than 40 x109 L, an activated partial thromboplastin time of more than 60 seconds, a prothrombin time of more than 2. 0 international normalized ratio, a recent major selleck Ruxolitinib bleeding, or active bleeding. Because all patients were treated according to local standards, the need for informed consent was waived Inhibitors,Modulators,Libraries for this study. Patients were also recruited from a second study which is a multi centered randomized controlled trial initiated in 2006. Patients admitted to the ICU who developed AKI necessitating CVVH without a high bleeding risk, were randomised between unfractionated heparin as anticoagulant or citrate. Only patients from our hospital were studied for this companion study. Informed consent was obtained from all study participants or their next of kin.

Study protocols were approved by the local medical ethical committee and performed in accordance with the Declaration of Helsinki. We pooled the studies because of the mechanistic nature of the current Inhibitors,Modulators,Libraries paper, without focus on patient centered outcomes. Treatment protocol The indication Inhibitors,Modulators,Libraries for CVVH was based on standard clinical criteria that include AKI accompanied by hemodynamic instability, ongoing hypercatabolism, diuretic resistant fluid overload, respiratory distress, multiorgan failure, or some combinations of these factors. CVVH was performed using a hemofiltration Inhibitors,Modulators,Libraries machine. Vascular access was obtained by the insertion of an 11 F double lumen catheter into the femoral, subclavian, or jugular vein. A 1. 9 m2 highly permeable cellulose triacetate filter was used in all treatments.

For lactate or bicarbonate based CVVH, commercially prepared buffer solutions were used. Patients with high serum lactate levels were routinely treated with bicarbonate buffered rather than lactate buffered CVVH. For the use of citrate, a replacement solution was custom made by Dirinco. Blood flow rate was set at 180 mL min in all groups. Replacement fluid was administered Inhibitors,Modulators,Libraries at a standard rate of 2000 mL h in the patients receiving no anticoagulation or heparin with bicarbonate or lactate containing replacement fluids. Replacement fluid rate in the citrate group was set at 2400 mL h and in all cases replacement fluids were infused in predilutional http://www.selleckchem.com/products/BI6727-Volasertib.html mode. Patients on heparin were administered a heparin bolus of 5000 IU followed by a body weight based continuous infusion targeting an aPTT between 45 55 seconds. Patients receiving citrate based therapy had a separate intravenous infusion with calcium glubionate.