Abstract
IntroductionRegional citrate anticoagulation (RCA) is gaining popularity in continous renal replacement therapy (CRRT) for critically ill patients. The risk of citrate toxicity is a primary concern during the prolonged process. The aim of this study was to assess the pharmacokinetics of citrate in critically ill patients with AKI, and used the kinetic parameters to predict the risk of citrate accumulation in this population group undergoing continuous veno-venous hemofiltration (CVVH) with RCA.MethodsCritically ill patients with AKI (n = 12) and healthy volunteers (n = 12) were investigated during infusing comparative dosage of citrate. Serial blood samples were taken before, during 120 min and up to 120 min after infusion. Citrate pharmacokinetics were calculated and compared between groups. Then the estimated kinetic parameters were applied to the citrate kinetic equation for validation in other ten patients’ CVVH sessions with citrate anticoagulation.ResultsTotal body clearance of citrate was similar in critically ill patients with AKI and healthy volunteers (648.04±347.00 L/min versus 686.64±353.60 L/min; P = 0.624). Basal and peak citrate concentrations were similar in both groups (p = 0.423 and 0.247, respectively). The predicted citrate curve showed excellent fit to the measurements.ConclusionsCitrate clearance is not impaired in critically ill patients with AKI in the absence of severe liver dysfunction. Citrate pharmacokinetic data can provide a basis for the clinical use of predicting the risk of citrate accumulation.Trial RegistrationClinicalTrials.gov Identifier NCT00948558
Highlights
Regional citrate anticoagulation (RCA) is gaining popularity in continous renal replacement therapy (CRRT) for critically ill patients
It is unknown whether critically ill patients with acute kidney injury (AKI) have difficulty with citrate metabolism
Twelve of 22 patients were involved for the investigation of the citrate pharmacokinetics, and as a comparative group, twelve age-and gender matched healthy volunteers without regular medications and a normal renal function according to the Modification of Diet in Renal Disease (MDRD) formula were enrolled
Summary
Regional citrate anticoagulation (RCA) is gaining popularity in continous renal replacement therapy (CRRT) for critically ill patients. The aim of this study was to assess the pharmacokinetics of citrate in critically ill patients with AKI, and used the kinetic parameters to predict the risk of citrate accumulation in this population group undergoing continuous veno-venous hemofiltration (CVVH) with RCA. Regional citrate anticoagulation (RCA), which restricts its powerful antithrombotic effect to the extracorporeal circuit, has been increasingly adopted as an alternative to heparin in critically ill patients with high risks of bleeding. Bauer et al [11] reported the citrate clearance was not impaired in patients with chronic renal failure. It is unknown whether critically ill patients with acute kidney injury (AKI) have difficulty with citrate metabolism
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