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Biocompatibility Parameters with Standard and Increased Dose of Citrate in Hemodialysis—A Randomized Trial
Background: The dose of citrate needed in regional citrate anticoagulation (RCA) to achieve optimal biocompatibility is unknown. We performed a randomized trial comparing two doses (ACTRN12613001340729). Methods: In 30 patients a single hemodialysis with either standard (2.7 mmol/L) or increased dos...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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MDPI
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8268353/ https://www.ncbi.nlm.nih.gov/pubmed/34279471 http://dx.doi.org/10.3390/jcm10132987 |
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author | Orsag, Alesa Bozic-Mijovski, Mojca Hudoklin, Samo Simcic, Sasa Gubensek, Jakob |
author_facet | Orsag, Alesa Bozic-Mijovski, Mojca Hudoklin, Samo Simcic, Sasa Gubensek, Jakob |
author_sort | Orsag, Alesa |
collection | PubMed |
description | Background: The dose of citrate needed in regional citrate anticoagulation (RCA) to achieve optimal biocompatibility is unknown. We performed a randomized trial comparing two doses (ACTRN12613001340729). Methods: In 30 patients a single hemodialysis with either standard (2.7 mmol/L) or increased dose of citrate (4 mmol/L) was performed. C5a-desArg, myeloperoxidase (MPO), thrombin-antithrombin complex (TAT), and platelet factor 4 (PF4) were measured and the inner surface of the dialyzer fibers was evaluated with scanning electron microscopy (SEM). Results: A good separation of anticoagulation effect was achieved (post-filter ionized calcium 0.20 vs. 0.31 mmol/L, p < 0.05). There was no effect of citrate dose on any of the biocompatibility parameters; transient and parallel increase in PF4 after 30 min and parallel increase in TAT after 4 h were observed. There were no visually detected clotting problems within the circuit and no significant hypocalcemia in either group. SEM clotting score was excellent and comparable in both groups (p = 0.59). Conclusions: Given the excellent results in both groups, absence of between group differences and inability of the increased dose of citrate to completely blunt the small residual increase in PF4 and TAT, we conclude that the standard dose of citrate seems sufficient in RCA for chronic hemodialysis. |
format | Online Article Text |
id | pubmed-8268353 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-82683532021-07-10 Biocompatibility Parameters with Standard and Increased Dose of Citrate in Hemodialysis—A Randomized Trial Orsag, Alesa Bozic-Mijovski, Mojca Hudoklin, Samo Simcic, Sasa Gubensek, Jakob J Clin Med Article Background: The dose of citrate needed in regional citrate anticoagulation (RCA) to achieve optimal biocompatibility is unknown. We performed a randomized trial comparing two doses (ACTRN12613001340729). Methods: In 30 patients a single hemodialysis with either standard (2.7 mmol/L) or increased dose of citrate (4 mmol/L) was performed. C5a-desArg, myeloperoxidase (MPO), thrombin-antithrombin complex (TAT), and platelet factor 4 (PF4) were measured and the inner surface of the dialyzer fibers was evaluated with scanning electron microscopy (SEM). Results: A good separation of anticoagulation effect was achieved (post-filter ionized calcium 0.20 vs. 0.31 mmol/L, p < 0.05). There was no effect of citrate dose on any of the biocompatibility parameters; transient and parallel increase in PF4 after 30 min and parallel increase in TAT after 4 h were observed. There were no visually detected clotting problems within the circuit and no significant hypocalcemia in either group. SEM clotting score was excellent and comparable in both groups (p = 0.59). Conclusions: Given the excellent results in both groups, absence of between group differences and inability of the increased dose of citrate to completely blunt the small residual increase in PF4 and TAT, we conclude that the standard dose of citrate seems sufficient in RCA for chronic hemodialysis. MDPI 2021-07-04 /pmc/articles/PMC8268353/ /pubmed/34279471 http://dx.doi.org/10.3390/jcm10132987 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Orsag, Alesa Bozic-Mijovski, Mojca Hudoklin, Samo Simcic, Sasa Gubensek, Jakob Biocompatibility Parameters with Standard and Increased Dose of Citrate in Hemodialysis—A Randomized Trial |
title | Biocompatibility Parameters with Standard and Increased Dose of Citrate in Hemodialysis—A Randomized Trial |
title_full | Biocompatibility Parameters with Standard and Increased Dose of Citrate in Hemodialysis—A Randomized Trial |
title_fullStr | Biocompatibility Parameters with Standard and Increased Dose of Citrate in Hemodialysis—A Randomized Trial |
title_full_unstemmed | Biocompatibility Parameters with Standard and Increased Dose of Citrate in Hemodialysis—A Randomized Trial |
title_short | Biocompatibility Parameters with Standard and Increased Dose of Citrate in Hemodialysis—A Randomized Trial |
title_sort | biocompatibility parameters with standard and increased dose of citrate in hemodialysis—a randomized trial |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8268353/ https://www.ncbi.nlm.nih.gov/pubmed/34279471 http://dx.doi.org/10.3390/jcm10132987 |
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