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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...

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Autores principales: Orsag, Alesa, Bozic-Mijovski, Mojca, Hudoklin, Samo, Simcic, Sasa, Gubensek, Jakob
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
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.
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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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