scholarly journals Ionized Magnesium and Regional Citrate Anticoagulation for Continuous Renal Replacement Therapy

2015 ◽  
Vol 41 (1-3) ◽  
pp. 41-47 ◽  
Author(s):  
Mychajlo Zakharchenko ◽  
Pavel Leden ◽  
Jan Rulíšek ◽  
Ferdinand Los ◽  
Helena Brodska ◽  
...  
Keyword(s):  
Blood Flow ◽  
Renal Replacement Therapy ◽  
Critically Ill Patients ◽  
Journal Club ◽  
Trisodium Citrate ◽  
Magnesium Concentration ◽  
Regional Citrate Anticoagulation ◽  
Citrate Anticoagulation ◽  
Continuous Venovenous Hemodiafiltration ◽  
Total Body

Background: The regional citrate anticoagulation (RCA) induces changes in total (Catot) and ionized (Ca2+) calcium. As of now, we do not have much information about parallel changes of total (Mgtot) and ionized (Mg2+) magnesium. Methods: The authors compared changes of Mg2+ and Mgtot with changes of Ca2+ and Catot in 32 critically ill patients on 4% trisodium citrate (4% TSC) with calcium-free fluids. Results: The median continuous venovenous hemodiafiltration balance of Mgtot was -0.91 (-1.18 to -0.53) mmol/h compared to the median balance of Catot 0.86 (0.08-1.55) mmol/h. Postfilter Mg2+ decreased by 68.3% (70.8-65.6) in parallel (r = 0.41, p = 0.03) to decrease of postfilter Ca2+ (by 70.2% (73.0-66.1)) and was significantly related to the postfilter Ca2+ (r = 0.50, p < 0.001). The decrease of prefilter to postfilter Ca2+ correlated to a dosage of 4% TSC per blood flow (r = 0.37, p = 0.04). Conclusions: The loss of Mgtot during RCA is not covered by magnesium concentration in ordinary dialysis/substitution fluid and may lead to the depletion of total body magnesium. The postfilter Mg2+ is significantly related to the postfilter Ca2+. Video Journal Club “Cappuccino with Claudio Ronco” at http://www.karger.com/?doi = 440972.

scholarly journals Citrate: How to get started and what, when, and how to monitor?

2018 ◽  
Vol 6 (3) ◽  
pp. 115-127 ◽  
Author(s):  
Patrick M. Honore ◽  
David De Bels ◽  
Thierry Preseau ◽  
Sebastien Redant ◽  
Herbert D. Spapen
Keyword(s):  
Clinical Practice ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill Patients ◽  
Trisodium Citrate ◽  
Review Article ◽  
Regional Citrate Anticoagulation ◽  
High Concentration ◽  
Citrate Anticoagulation ◽  
Bactericidal Agent

Abstract In most of the case, regional citrate anticoagulation is using diluted citrate around 1% depending on the types used in clinical practice. Diluted citrate is much more safer when compared to highly concentrated citrate around 4% or even more. In clinical practice, trisodium citrate is used in high concentration (around 30%) as a bactericidal agent with anticoagulant properties for locking deep venous catheters used in hemodialysis (HD; close to 25–30% of citrate). In this review article, buffer and anticoagulant potential of citrate are discussed during renal replacement therapy in critically ill patients with particular focus on the practical approach at the bedside.

scholarly journals Regional citrate versus systemic heparin anticoagulation for continuous renal replacement therapy in critically ill patients with acute kidney injury (RICH) trial: study protocol for a multicentre, randomised controlled trial

BMJ Open ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. e024411 ◽  
Author(s):  
Melanie Meersch ◽  
Mira Küllmar ◽  
Carola Wempe ◽  
Detlef Kindgen-Milles ◽  
Stefan Kluge ◽  
...  
Keyword(s):  
Overall Survival ◽  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Critically Ill Patients ◽  
Kidney Injury ◽  
Ethics Committee ◽  
Regional Citrate Anticoagulation ◽  
Citrate Anticoagulation ◽  
Heparin Anticoagulation

IntroductionAcute kidney injury (AKI) is a well-recognised complication of critical illness which is of crucial importance for morbidity, mortality and health resource utilisation. Renal replacement therapy (RRT) inevitably entails an escalation of treatment complexity and increases costs for those patients with severe AKI. However, it is still not clear whether regional citrate anticoagulation or systemic heparin anticoagulation for continuous RRT (CRRT) is most appropriate. We hypothesise that, in contrast to systemic heparin anticoagulation, regional citrate anticoagulation for CRRT prolongs filter life span and improves overall survival in a 90-day follow-up period (coprimary endpoints).Methods and analysisWe will conduct a prospective, randomised, multicentre, clinical trial including up to 1450 critically ill patients with AKI requiring CRRT. We suggest to investigate the effect of regional citrate anticoagulation for CRRT as compared with systemic heparin anticoagulation. The two coprimary outcomes are filter life span and overall survival in a 90-day follow-up period. Secondary outcomes are length of stay in the intensive care unit; length of hospitalisation; duration of CRRT; recovery of renal function at days 28, 60, 90 and 1 year; requirement for RRT after days 28, 60, 90 and 1 year; 28 days, 60 days, 90 days and 1-year all-cause mortality; major adverse kidney events at days 28, 60, 90 and 1 year; bleeding complications; transfusion requirements; infection rate and costs of RRT. Additionally, in an add-on study involving several of the participating centres, blood samples from recruited patients will be collected at different time points to analyse whether the anticoagulation strategy has an impact on immune response as evidenced by leucocyte recruitment and function.Ethics and disseminationThe RICH trial has been approved by the Federal Institute for Drugs and Medical Devices, the leading Ethics Committee of the University of Münster and the corresponding Ethics Committee at each participating site.Trial registration numberNCT02669589.

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