Abstract
Introduction:Heparin and citrate are commonly used anticoagulants in membrane/adsorption based extracorporeal liver support systems. However, anion exchange resins employed for the removal of negatively charged target molecules including bilirubin may also deplete these anticoagulants due to their negative charge. The aim of this study was to evaluate the adsorption of citrate by anion exchange resins and the impact on extracorporeal Ca2+ concentrations.Methods:Liver support treatments were simulated in vitro. Citrate and Ca2+ concentrations were measured pre and post albumin filter as well as pre and post adsorbents. In addition, batch experiments were performed to quantify citrate adsorption.Results:Pre albumin filter target Ca2+ concentrations were reached well with only minor deviations. Citrate was adsorbed by anion exchange resins, resulting in a higher Ca2+ concentration downstream of the adsorbent cartridges during the first hour of treatment.Conclusions:The anion exchange resin depletes citrate, leading to an increased Ca2+ concentration in the extracorporeal circuit, which may cause an increased risk of clotting during the first hour of treatment. An increase of citrate infusion during the first hour of treatment should therefore be considered to compensate for the adsorption of citrate.
Highlights
Heparin and citrate are commonly used anticoagulants in membrane/adsorption based extracorporeal liver support systems
Clotting problems during adsorbent-based extracorporeal liver support can be due to disturbances of the clotting system in patients suffering from liver diseases
Adsorption of negatively charged clotting factors and its regulators by anion exchange resins can aggravate the imbalance of the coagulation system, favoring its activation.[17]
Summary
Heparin and citrate are commonly used anticoagulants in membrane/adsorption based extracorporeal liver support systems. The aim of this study was to evaluate the adsorption of citrate by anion exchange resins and the impact on extracorporeal Ca2+ concentrations. Citrate was adsorbed by anion exchange resins, resulting in a higher Ca2+ concentration downstream of the adsorbent cartridges during the first hour of treatment. Conclusions: The anion exchange resin depletes citrate, leading to an increased Ca2+ concentration in the extracorporeal circuit, which may cause an increased risk of clotting during the first hour of treatment. In patients suffering from liver disease with impaired coagulation, heparin can further contribute to hemorrhagic complications during extracorporeal liver support therapy,[1] as it exerts its anticoagulatory activity in the extracorporeal circuit and systemically. Citrate exerts antiinflammatory properties in extracorporeal blood purification[2,3,4,5] and is associated with longer filter lifetimes.[6,7]
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