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Citrate pharmacokinetics in critically ill liver failure patients receiving CRRT

Citrate has been proposed as anticoagulation of choice in continuous renal replacement therapy (CRRT). However, little is known about the pharmacokinetics (PK) and metabolism of citrate in liver failure patients who require CRRT with regional citrate anticoagulation (RCA). This prospective clinical...

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Autores principales: Thanapongsatorn, Peerapat, Chaijamorn, Weerachai, Sirivongrangson, Phatadon, Tachaboon, Sasipha, Peerapornratana, Sadudee, Lumlertgul, Nuttha, Lucksiri, Aroonrut, Srisawat, Nattachai
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Nature Publishing Group UK 2022
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Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8810887/
https://www.ncbi.nlm.nih.gov/pubmed/35110648
http://dx.doi.org/10.1038/s41598-022-05867-8
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author Thanapongsatorn, Peerapat
Chaijamorn, Weerachai
Sirivongrangson, Phatadon
Tachaboon, Sasipha
Peerapornratana, Sadudee
Lumlertgul, Nuttha
Lucksiri, Aroonrut
Srisawat, Nattachai
author_facet Thanapongsatorn, Peerapat
Chaijamorn, Weerachai
Sirivongrangson, Phatadon
Tachaboon, Sasipha
Peerapornratana, Sadudee
Lumlertgul, Nuttha
Lucksiri, Aroonrut
Srisawat, Nattachai
author_sort Thanapongsatorn, Peerapat
collection PubMed
description Citrate has been proposed as anticoagulation of choice in continuous renal replacement therapy (CRRT). However, little is known about the pharmacokinetics (PK) and metabolism of citrate in liver failure patients who require CRRT with regional citrate anticoagulation (RCA). This prospective clinical PK study was conducted at King Chulalongkorn Memorial Hospital between July 2019 to April 2021, evaluating seven acute liver failure (ALF) and seven acute-on-chronic liver failure (ACLF) patients who received CRRT support utilizing RCA as an anticoagulant at a citrate dose of 3 mmol/L. For evaluation of the citrate PK, we delivered citrate for 120 min and then stopped for a further 120 min. Total body clearance of citrate was 152.5 ± 50.9 and 195.6 ± 174.3 mL/min in ALF and ACLF, respectively. The ionized calcium, ionized magnesium, and pH slightly decreased after starting citrate infusion and gradually increased to baseline after stopping citrate infusion. Two of the ACLF patients displayed citrate toxicity during citrate infusion, while, no ALF patient had citrate toxicity. In summary, citrate clearance was significantly decreased in critically ill ALF and ACLF patients receiving CRRT. Citrate use as an anticoagulation in these patients is of concern for the risk of citrate toxicity.
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spelling pubmed-88108872022-02-03 Citrate pharmacokinetics in critically ill liver failure patients receiving CRRT Thanapongsatorn, Peerapat Chaijamorn, Weerachai Sirivongrangson, Phatadon Tachaboon, Sasipha Peerapornratana, Sadudee Lumlertgul, Nuttha Lucksiri, Aroonrut Srisawat, Nattachai Sci Rep Article Citrate has been proposed as anticoagulation of choice in continuous renal replacement therapy (CRRT). However, little is known about the pharmacokinetics (PK) and metabolism of citrate in liver failure patients who require CRRT with regional citrate anticoagulation (RCA). This prospective clinical PK study was conducted at King Chulalongkorn Memorial Hospital between July 2019 to April 2021, evaluating seven acute liver failure (ALF) and seven acute-on-chronic liver failure (ACLF) patients who received CRRT support utilizing RCA as an anticoagulant at a citrate dose of 3 mmol/L. For evaluation of the citrate PK, we delivered citrate for 120 min and then stopped for a further 120 min. Total body clearance of citrate was 152.5 ± 50.9 and 195.6 ± 174.3 mL/min in ALF and ACLF, respectively. The ionized calcium, ionized magnesium, and pH slightly decreased after starting citrate infusion and gradually increased to baseline after stopping citrate infusion. Two of the ACLF patients displayed citrate toxicity during citrate infusion, while, no ALF patient had citrate toxicity. In summary, citrate clearance was significantly decreased in critically ill ALF and ACLF patients receiving CRRT. Citrate use as an anticoagulation in these patients is of concern for the risk of citrate toxicity. Nature Publishing Group UK 2022-02-02 /pmc/articles/PMC8810887/ /pubmed/35110648 http://dx.doi.org/10.1038/s41598-022-05867-8 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Article
Thanapongsatorn, Peerapat
Chaijamorn, Weerachai
Sirivongrangson, Phatadon
Tachaboon, Sasipha
Peerapornratana, Sadudee
Lumlertgul, Nuttha
Lucksiri, Aroonrut
Srisawat, Nattachai
Citrate pharmacokinetics in critically ill liver failure patients receiving CRRT
title Citrate pharmacokinetics in critically ill liver failure patients receiving CRRT
title_full Citrate pharmacokinetics in critically ill liver failure patients receiving CRRT
title_fullStr Citrate pharmacokinetics in critically ill liver failure patients receiving CRRT
title_full_unstemmed Citrate pharmacokinetics in critically ill liver failure patients receiving CRRT
title_short Citrate pharmacokinetics in critically ill liver failure patients receiving CRRT
title_sort citrate pharmacokinetics in critically ill liver failure patients receiving crrt
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8810887/
https://www.ncbi.nlm.nih.gov/pubmed/35110648
http://dx.doi.org/10.1038/s41598-022-05867-8
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