Maximum acceptable infusion rate of citrate: Relationship between blood ionized calcium levels and cardiovascular effects in anesthetized rats

Toyoshima, Shigeki; Fukuda, T; Masumi, Shigeru; Nakashima, Yoshifumi; Kawaguchi, Yoshiro; Nakayama, Mitsuo

doi:10.1016/j.clnu.2006.01.010

Cited by 5 publications

(6 citation statements)

References 17 publications

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“…Ionized calcium levels required for hemodynamic stability were kept within the physiological range [19, 20] by infusion of 10% calcium gluconate at fixed rates.…”

Section: Discussionmentioning

confidence: 99%

Citrate shows protective effects on cardiovascular and renal function in ischemia-induced acute kidney injury

et al. 2017

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BackgroundIschemia and reperfusion (I/R) is one of the major causes of acute kidney injury (AKI). Citrate reduces hypoxia-induced mitochondrial energetic deficits in isolated proximal tubules. Moreover, citrate anticoagulation is now frequently used in renal replacement therapy. In the present study a rat model of I/R-induced AKI was utilized to examine renal protection by citrate in vivo.MethodsAKI was induced by bilateral renal clamping (40 min) followed by reperfusion (3 h). Citrate was infused at three different concentrations (0.3 mmol/kg/h; 0.6 mmol/kg/h and 1.0 mmol/kg/h) continuously for 60 min before and 45 min after ischemia. Plasma calcium concentrations were kept stable by infusion of calcium gluconate. The effect of citrate was evaluated by biomonitoring, blood and plasma parameters, histopathology and tissue ATP content.ResultsIn comparison to the normoxic control group bilateral renal ischemia led to an increase of creatinine and lactate dehydrogenase activity and a decrease in tissue ATP content and was accompanied by a drop in mean arterial blood pressure. Infusion of 1.0 mmol/kg/h citrate led to lower creatinine and reduced LDH activity compared to the I/R control group and a tendency for higher tissue ATP content. Pre-ischemic infusion of 1.0 mmol/kg/h citrate stabilized blood pressure during ischemia.ConclusionsCitrate has a protective effect during I/R-induced AKI, possibly by limiting the mitochondrial deficit as well as by beneficial cardiovascular effects. This strengthens the rationale of using citrate in continuous renal replacement therapy and encourages consideration of citrate infusion as a therapeutic treatment for AKI in humans.Electronic supplementary materialThe online version of this article (doi:10.1186/s12882-017-0546-1) contains supplementary material, which is available to authorized users.

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“…Ionized calcium levels required for hemodynamic stability were kept within the physiological range [19, 20] by infusion of 10% calcium gluconate at fixed rates.…”

Section: Discussionmentioning

confidence: 99%

Citrate shows protective effects on cardiovascular and renal function in ischemia-induced acute kidney injury

et al. 2017

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“…after apheresis. Toyoshima et al (2006) explained hypotension following infusion of citrate at a rate >1.0 mmol/kg/h by hypocalcemia which is more severe with increased infusion rate of citrate. Tachycardia also reported in such cases and is believed to be a reflex for hypotension.…”

Section: Discussionmentioning

confidence: 99%

Effect of acid citrate dextrose during plateletpheresis on first-time healthy donors: Between safety and toxicity

Elfakharany

El-Nagdy

2019

Zagazig Journal of Forensic Medicine

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Introduction: During apheresis, anticoagulation is accomplished by use of acid citrate dextrose (ACD). Acid citrate dextrose returns to the donor with the remainder of blood after separation of the targeted blood component. Objectives: This study was conducted to assess the potential toxic effects of ACD in first-time blood donors through clinical and biochemical assessment. Methodology: Seventy -five healthy plateletpheresis donors were recruited in the study where they were subjected to clinical and laboratory assessment just before the procedure (baseline), at 30 min. & at 60 min. during the procedure and 30 min. post procedure. Clinical evaluation included vital signs evaluation and reporting of any clinical manifestation developed. Biochemical assessment included ABG, serum ionized Ca (iCa), ionized Mg (iMg) and parathyroid hormone (PTH) levels. Also activity of erythrocyte phosphofructokinase (PFK) and hematological parameters including RBCs (million/ul), hemoglobin level (Hb g/dl) and hematocrite (Hct %) were evaluated. Results: Apheresis using citrate anticoagulant resulted in changes in mineral homeostasis in the form of hypocalcemia and hypomagnesemia with subsequent tremors (9.3%) and tetany (5.3%). Also, some of the donors exhibited tachycardia and hypotension. Parathyroid hormone (PTH) level increased during apheresis which nearly returned to normal level 30 min. after the procedure while, no significant changes in ABG were detected at different time intervals of the procedure. When RBCs PFK activity was measured, a significant decrease was found during the procedure with significant decrease in RBCs at 60 min. and post 30 min. But no significant changes were detected as regard Hb level and Hct % in comparison to baseline ones. Conclusion: Citrate toxicity may occur even with first time exposure in platelet apheresis donors in form of possible developing tremors, tetany, tachycardia and hypotension with decreased calcium & magnesium levels, increased PTH, decreased erythrocyte PFK activity with subsequent decreased RBCs integrity and possible hemolysis.

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“…During apheresis, the decrease in the level of calcium ions may cause prolongation of the plateau phase of myocardial depolarization, and this occasionally displays itself as prolongation of the QTc interval on electrocardiogram (Hester et al , 1983; Meikle & Milne, 2000; Laspina et al , 2002; Raj et al , 2005). In case of prolongation of QTc, plasma calcium values (a marker of citrate toxicity at the myocardial level) should be analysed (Roberts et al , 1984; Toyoshima et al , 2006). Furthermore, a decreased level of magnesium in plasma (total or ionized) can also exert a significant effect on QTc interval duration (Bolan et al , 2004; Meenagh et al , 2004; Haddad et al , 2005; Hoshino et al , 2006).…”

Section: Discussionmentioning

confidence: 99%

Assessment of corrected QT interval in sickle cell disease patients who undergo erythroapheresis

Boğa

Kozanoğlu

Yeral

et al. 2007

Transfusion Medicine

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Extension of the QT interval is characterized by syncope and cardiac arrest and often occurs in association with medical therapies and procedures. Whether erythroapheresis (EPH) could influence the QT interval duration in patients with sickle cell disease (SCD) is not known. We aimed to investigate the effects of EPH on the heart rate-corrected QT (QTc) interval. The study included 25 patients with SCD who underwent 34 EPH procedures. Two independent observers measured QTc interval duration from electrocardiograms performed continuously for 3 min at three different points during the EPH procedures (prior to EPH, after completion of 50% EPH and 15 min after EPH). Multiple regression analysis was used to determine if the ionized plasma calcium, the level of plasma magnesium, citrate infusion rate and painful crisis significantly contributed to the QTc interval. There was a non-significant trend (P = 0.184) towards increased QTc in sickle cell patients during EPH compared with pre-EPH values. QTc prolongation (>440 ms) occurred in 72% of the procedures. Fifty percent QTc values returned to baseline after the procedure. The independent variables were not significantly associated with QTc interval. Exchange procedures can induce QTc prolongation in patients with SCD.

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Maximum acceptable infusion rate of citrate: Relationship between blood ionized calcium levels and cardiovascular effects in anesthetized rats

Cited by 5 publications

References 17 publications

Citrate shows protective effects on cardiovascular and renal function in ischemia-induced acute kidney injury

Citrate shows protective effects on cardiovascular and renal function in ischemia-induced acute kidney injury

Effect of acid citrate dextrose during plateletpheresis on first-time healthy donors: Between safety and toxicity

Assessment of corrected QT interval in sickle cell disease patients who undergo erythroapheresis

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