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 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.

Clinical Impact of Regional Citrate Anticoagulation in Continuous Renal Replacement Therapy in Critically Ill Patients

2017 ◽  
Vol 40 (12) ◽  
pp. 676-682 ◽  
Author(s):  
Maria Huguet ◽  
Lida Rodas ◽  
Miquel Blasco ◽  
Luis F. Quintana ◽  
Jordi Mercadal ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Red Blood Cell Transfusion ◽  
Regional Citrate Anticoagulation ◽  
Transfusion Rate ◽  
Metabolic Disturbances ◽  
Heparin Group ◽  
Metabolic Complications ◽  
Citrate Anticoagulation

Background Regional citrate anticoagulation (RCA) is being used increasingly in continuous renal replacement therapy (CRRT) as a safer alternative to heparin. However, complex metabolic control to avoid side effects have generated discrepancies about its introduction into everyday practice. We aimed to compare both anticoagulation techniques in terms of efficacy, safety and feasibility. Methods Observational retrospective study performed in 3 specialized ICUs in patients receiving CVVHDF with RCA between January 2013 and May 2016. Heparin-treated patients matched by age, sex and disease severity treated in the preceding year were selected as historic controls. Filter lifetime, number of filters used, haemorrhagic complications and metabolic complications were recorded. Results 54 patients (27 treated with RCA and 27 with heparin) were included in the study. Filter lifetimes in the first 72 hours were 55.1 ± 21.8 hours in the RCA group compared to 38.8 ± 24.8 hours in the heparin group, (p = 0.004). In addition, the number of filters used in the first 72 hours was significantly higher in the heparin group (2.4 ± 1.3 vs. 1.5 ± 0.7; p = 0.004). There was a trend toward a lower incidence of bleeding in the RCA group, with a significantly lower red blood cell transfusion rate (p = 0.027) in the citrate group. No clinically significant metabolic disturbances were observed in the RCA group. Regarding outcomes, there were no significant differences between groups. Conclusions These results suggest that the implementation of CVVHDF with RCA using concentrated citrate solutions prolongs filter lifetime, achieves a longer effective hemodiafiltration time and is a safe and feasible method.

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