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

Freitas

Can J Kidney Health Dis

et al. 2021

Rationale: Protocols for regional citrate anticoagulation with the hypertonic 4% trisodium citrate solution have been recently described as an anticoagulation strategy during membrane therapeutic plasma exchange (mTPE). The effect of citrate in the patient’s systemic hemostasis is negligible, thus regional citrate anticoagulation application is advantageous in circumstances in which heparin-based protocols are deemed unsafe for patients with a high risk of bleeding. The downsides of using hypertonic citrate solutions are mainly hypocalcemia and hypernatremia that ultimately can cause adverse clinical events. Presenting concerns of the patient: (1) A 57-year-old Caucasian female with a history of active vaginal bleeding secondary to endometrial hyperplasia. She had a history of antiphospholipid syndrome, and systemic lupus erythematosus with marked refractory autoimmune thrombocytopenia. Her platelet count was persistently below 4,000/mm3 even after different immunosuppressive regimens and daily platelet transfusions. (1) A 70-year-old Caucasian female was hospitalized presenting acute kidney injury stage 3 due to rapidly progressive antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis, however without the need for renal replacement therapy. At admission, serum creatinine (sCr) was 3.56 mg/dL (normal range: 0.53-1.00 mg/dL). Her baseline sCr was 0.8 mg/dL obtained 6 months earlier. Chest tomography revealed bilateral masses compatible with granulomatous lesions and no signs of alveolar bleeding. Since severe cases of ANCA vasculitis involving the lungs may evolve with alveolar hemorrhage, heparin was avoided. Diagnoses: (1) Systemic lupus erythematosus-associated autoimmune thrombocytopenia and (2) ANCA-associated vasculitis with kidney and lung involvement. Interventions: Herein, we describe a case series of 12 consecutive mTPE treatments in 2 different patients using regional 4% trisodium citrate anticoagulation. Outcomes: All the sessions were uneventful, presented only minor electrolyte imbalances, and were effectively completed without early interruptions due to clotting of the plasmafilter. Teaching points: In our 2 cases, extracorporeal regional citrate anticoagulation was successful in optimizing plasmafilter patency without bleeding events in 2 high-risk patients using established protocols for the citrate and calcium infusions.

Section: Discussioncontrasting

confidence: 41%

Regional Hypertonic Citrate Anticoagulation in Membrane Therapeutic Plasma Exchange: A Case Series

Freitas

Can J Kidney Health Dis

et al. 2021

“…For example, it is an important intermediate in the tricarboxylic acid cycle which is the primary source of energy for cells while constitutes an integral part of aerobic respiration [24] . The sodium citrate is used as the blood anticoagulant in processing of the blood samples and during the hemofiltration and haemodialysis as citrate ion chelates the Ca 2+ ion which is an essential component in blood clotting process [25] . It is also widely used in food and pharmaceutical industries [22] .…”

Section: Introductionmentioning

confidence: 99%

“…[24] The sodium citrate is used as the blood anti-coagulant in processing of the blood samples and during the hemofiltration and haemodialysis as citrate ion chelates the Ca 2 + ion which is an essential component in blood clotting process. [25] It is also widely used in food and pharmaceutical industries. [22] However, excessive use and concentration of citrate ion can cause various disorders such as nephrolithiasis, nephrocalcinosis and glycogen storage disease.…”

Section: Introductionmentioning

confidence: 99%

Coumarin‐Based Reversible Fluorescent Chemosensors for the Sequential Detection of Copper and Citrate Ions

2022

Two novel coumarin-based Schiff-base chemosensors are presented. Courtesy to an extended conjugation between the coumarin ring and the attached π-containing groups, both chemosensors display noteworthy photo-physical properties including emission maxima at > 550 nm. Both chemosensors function as the selective sensors for the 'turn-off' detection of copper ion with the significant nanomolar detection limits. The sensing event was investigated through proton NMR and mass spectroscopy; pH studies; life-time and quantum yield measurements and DFT studies. The solution-generated [chemosensor-Cu] species illustrated remarkably selective secondary 'turn-on' detection of the citrate ion. The sequential detection of the copper and citrate ions have been utilized for the construction of logic gates as well as several low-cost detection methods.

“…Continuous renal replacement therapy (CRRT) is a widely used approach for the treatment of critically ill children [1][2][3]. This therapy usually has a duration of hours or even days.…”

Section: Introductionmentioning

confidence: 99%

Citrate-Based Self-Circulation Anticoagulation Protocol for Discontinuity of Continuous Renal Replacement Therapy

Weng

Zhou

et al. 2020

Blood Purif

Background/Aims: Continuous renal replacement therapy (CRRT) has been used widely in the treatment of critically ill children for its continuity. However, sometimes we have to interrupt the continuity for necessary surgeries or blood transfusions. Our objective was to demonstrate a feasible self-circulation anticoagulation protocol based on citrate (CSAP) to address discontinuity during CRRT. Methods: We conducted a prospective observational study of 57 pediatric patients undergoing 88 CRRT sessions that were receiving CSAP during the treatment discontinuity period by using an anticoagulation regimen containing 5 mL 4% sodium citrate in 50 mL of saline to maintain the continuity. We documented the reasons for CSAP and the total duration of the treatment. We assessed the in-line pressure recordings, blood routine examination, blood electrolytes, and blood gas analysis before, throughout, and after the period of CSAP. Results: The average duration of CSAP was 118.5 ± 45.3 min. There was no significant increase in arterial pressures, ve-nous pressures, and transmembrane pressures and no significant decreases in blood cell counts observed at the end of the CSAP, compared to the data recorded at the beginning of the CSAP. Compared to before the CSAP, there was no significant change in the ratio of total to ionized calcium, Na + , HCO 3-, and pH value after CSAP. Conclusions: CSAP might be a safe, effective, and easy approach for use during the treatment discontinuity of CRRT in children.