Correlation among ionized calcium, citrate, and total calcium levels during hepatic transplantation

Díaz, José Carlos Losada; Acosta, F; Parrilla, Pascual; Sansano, T; Contreras, Rafael; Bueno, F.S; Martínez, P.

doi:10.1016/0009-9120(94)00094-c

Cited by 37 publications

(24 citation statements)

References 10 publications

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“…However, only 1 patient reached the critical threshold after 45 L. Citrate accumulation comprises the risk of hypocalcemia due to complex binding with Caion [21][22][23]. In our study, no severe decrease in Caion was observed.…”

Section: Discussioncontrasting

confidence: 61%

Sustained low-efficiency dialysis with regional citrate anticoagulation in medical intensive care unit patients with liver failure: A prospective study

Lahmer

Messer

Rasch

et al. 2015

Journal of Critical Care

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Section: Discussioncontrasting

confidence: 61%

Sustained low-efficiency dialysis with regional citrate anticoagulation in medical intensive care unit patients with liver failure: A prospective study

Lahmer

Messer

Rasch

et al. 2015

Journal of Critical Care

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“…Metabolic acidosis could be the result of large doses of citrates not being metabolized; metabolic alkalosis could be the result of mass delivering of sodium citrates (eg. accidentally rapid infusion or protocol violation); hypernatremia could be the result of the sodium not being reduced proportionally in the solution, leaving the unopposed sodium [42][43][44]; hypomagnesemia could be the result of citrates binding to Mg 2+ [33]. However, the results of our study showed that neither did the accumulation degree of citrates nor the severity of liver dysfunction interfere with serum pH values, or concentrations of Na + or Mg…”

Section: Discussioncontrasting

confidence: 53%

Applying Regional Citrate Anticoagulation in Continuous Renal Replacement Therapy for Acute Kidney Injury Patients with Acute Liver Dysfunction: a Retrospective Observational Study

Yu¹,

Peng²,

Cen³

et al. 2018

Kidney Blood Press Res

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Background/Aims: Continuous renal replacement therapy (CRRT) is a treatment for acute kidney injury (AKI) patients. It has become a controversy about whether patients with liver dysfunction should perform CRRT with regional citrate anticoagulation (RCA). Methods: This retrospective observational study enrolled 145 AKI patients (275 CRRT sessions) who received CRRT with RCA and had no history of chronic liver disease. Circuit survival time, blood pressure, trans-membrane pressure (TMP), acid-base and electrolyte status were recorded and analyzed. The severity of liver dysfunction was determined by total bilirubin (TBil) and international normalized ratio (INR), while the accumulation degree of citrates was quantified by total/ ionized calcium (tCa/iCa) raito. Results: Our results showed that there was no correlation of tCa/iCa ratio with TBil or INR. And tCa/iCa ratio was not related to the disturbances of pH, lactates, sodium, magnesium, blood pressure or TMP despite that high tCa/iCa ratios might be related to the decrease of circuit survival time. TBil did not correlate with the above indexes, except for lactates levels. INR did not correlate with the above indexes except for lactates levels and blood pressure. In addition, neither was TBil, INR, nor tCa/iCa ratio, related with fatal outcomes (22.76% of the patients). Conclusion: The present study demonstrated that, with proper monitoring and adjustment of citrates and calcium infusion, applying RCA in CRRT is reasonably safe for AKI patients with acute liver dysfunction, as long as circuit time stays below roughly 50 hours.

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“…Hypercalcemia is a well-known problem during citrate anticoagulation as well [19, 20]. It is particularly pronounced in patients with slowed down citrate metabolism due to impaired liver function [20].…”

Section: Discussionmentioning

confidence: 99%

Metabolic Complications during Regional Citrate Anticoagulation in Continuous Venovenous Hemodialysis: Single-Center Experience

Morgera¹,

Scholle²,

Voss³

et al. 2004

Nephron Clin Pract

100

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Background: Regional anticoagulation with trisodium citrate is an effective form of anticoagulation for continuous renal replacement therapy (CRRT) in patients at a high risk of bleeding. In a prospective, observational study we compared an established regional citrate anticoagulation protocol [Mehta R et al: Kidney Int 1990;38:976–981] versus a standard heparin anticoagulation protocol focusing on acid-base and electrolyte derangements as well as on cost effectiveness. Methods and Results: 209 patients were included in the study. In 37 patients, citrate was used as the sole anticoagulant, 87 patients received low-dose heparin plus citrate, and 85 patients received only heparin as anticoagulant. A customized dialysate solution was used for citrate-anticoagulated CRRT (no buffer, no calcium, reduced sodium concentration). Filter life was significantly higher during citrate anticoagulation compared to heparin anticoagulation (80.2 ± 60 vs. 30.2 ± 32 h; p < 0.001). No difference was found between citrate and citrate-heparin anticoagulation (p = 0.310). Metabolic alkalosis was observed in more than 50% of patients on citrate anticoagulation. Alkalosis developed within the first 72 h after initiating treatment and could be reversed in almost all cases by increasing the dialysate flow rate. Hypercalcemia was observed in 13 patients on citrate anticoagulation. Patients with impaired liver function were particularly at risk. Systemic hypocalcemia, hypernatremia, and anion gap acidosis were not observed. Citrate anticoagulation was well tolerated hemodynamically. A longer filter life during citrate anticoagulation translated into a significant cost reduction compared to standard heparin anticoagulation (p < 0.01). Conclusion: Regional anticoagulation with trisodium citrate in combination with a customized calcium-free dialysate is a safe and effective alternative to a heparin-based anticoagulation regimen.

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Correlation among ionized calcium, citrate, and total calcium levels during hepatic transplantation

Cited by 37 publications

References 10 publications

Sustained low-efficiency dialysis with regional citrate anticoagulation in medical intensive care unit patients with liver failure: A prospective study

Sustained low-efficiency dialysis with regional citrate anticoagulation in medical intensive care unit patients with liver failure: A prospective study

Applying Regional Citrate Anticoagulation in Continuous Renal Replacement Therapy for Acute Kidney Injury Patients with Acute Liver Dysfunction: a Retrospective Observational Study

Metabolic Complications during Regional Citrate Anticoagulation in Continuous Venovenous Hemodialysis: Single-Center Experience

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