Citrate kinetics during regional citrate anticoagulation in extracorporeal organ replacement therapy
type: CreativeWork
description: Regional citrate anticoagulation is an important alternative anticoagulation method for haemodialysis patients at high risk of bleeding. In order to better define the optimal dose of citrate and calcium infusion and to identify patients at risk for side effects, the kinetics of citrate and calcium were studied in vivo during and after 15 haemodialysis treatments and in vitro assessing the clearance of citrate-calcium complexes by F60S dialyzers. In addition, a mathematical model was developed to identify the parameters affecting calcium and citrate kinetics in order to predict citrate and calcium requirements in individual patients to avoid side effects. Citrate and calcium doses for effective anticoagulation Citrate dose should be adapted not only to blood flow (approx. 3 mmol per litre of blood) but also to hematocrit. Patients with low hematocrit need more citrate, because they have more plasma water per litre of blood. Sodium concentration in the dialysate of 138 mmol/l does not require any adaptation. Bicarbonate in the dialysate should be reduced by 4 mmol/l (e.g. from 32 to 28 mmol/l). Calcium supplementation should be at least as high as calcium removal by the dialyzer. Calcium removal is higher in patients with high initial total calcium, with use of effective high flux dialyzers, and with high blood flow. With use of high flux dialyzers previous recommendations of calcium supplementation in the literature may no longer be valid, because of the more efficient removal of calcium into the calcium free dialysate. Ionized calcium has to be monitored in the arterial line prior to citrate infusion for safety reasons, in order to detect any trend towards hypocalcemia. Risk assessment Citrate toxicity within the citrate concentration ranges that can be reached in intermittent haemodialysis is limited to the disturbances of ionized calcium concentration, mainly to the induction of hypocalcemia. Hypercalcemia rarely develops, probably due to calcium uptake e.g. by th…
abstract: Regional citrate anticoagulation is an important alternative anticoagulation method for haemodialysis patients at high risk of bleeding. In order to better define the optimal dose of citrate and calcium infusion and to identify patients at risk for side effects, the kinetics of citrate and calcium were studied in vivo during and after 15 haemodialysis treatments and in vitro assessing the clearance of citrate-calcium complexes by F60S dialyzers. In addition, a mathematical model was developed to identify the parameters affecting calcium and citrate kinetics in order to predict citrate and calcium requirements in individual patients to avoid side effects. Citrate and calcium doses for effective anticoagulation Citrate dose should be adapted not only to blood flow (approx. 3 mmol per litre of blood) but also to hematocrit. Patients with low hematocrit need more citrate, because they have more plasma water per litre of blood. Sodium concentration in the dialysate of 138 mmol/l does not require any adaptation. Bicarbonate in the dialysate should be reduced by 4 mmol/l (e.g. from 32 to 28 mmol/l). Calcium supplementation should be at least as high as calcium removal by the dialyzer. Calcium removal is higher in patients with high initial total calcium, with use of effective high flux dialyzers, and with high blood flow. With use of high flux dialyzers previous recommendations of calcium supplementation in the literature may no longer be valid, because of the more efficient removal of calcium into the calcium free dialysate. Ionized calcium has to be monitored in the arterial line prior to citrate infusion for safety reasons, in order to detect any trend towards hypocalcemia. Risk assessment Citrate toxicity within the citrate concentration ranges that can be reached in intermittent haemodialysis is limited to the disturbances of ionized calcium concentration, mainly to the induction of hypocalcemia. Hypercalcemia rarely develops, probably due to calcium uptake e.g. by th…
author: Kozik-Jaromin, Justyna
keywords: Calciumsalze, Calciumkomplexe, Calciumhomöostase, Calcium, dialysis, citrate, anticoagulation, pharmacokinetics
date modified: 2026-07-24T02:22:40Z
provider: University of Freiburg
publisher: Networked Digital Library of Theses and Dissertations
type: WebPage
source organization: University of Freiburg