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Citrate dialysis

Meng-Ling Chen, Hung-Yi Su
A 59-year-old woman presented with fever for 2 weeks. The patient had end-stage renal disease and was undergoing dialysis therapy for 10 years. Plain radiographs revealed extensive calcification in the subcutaneous tissues of the shoulders, thighs, and hips. In this case, TC-MDP bone scan detected all sites of subcutaneous metastatic calcification in one sweep. Ga-citrate scintigraphy was also performed and showed similar uptake at the same locations as those revealed by the bone scan, suggesting the existence of an inflammatory process at the sites of metastatic calcification...
October 23, 2018: Clinical Nuclear Medicine
Richen Li, Mahmoud Elsabahy, Yue Song, Hai Wang, Lu Su, Rachel A Letteri, Sarosh Khan, Gyu Seong Heo, Guorong Sun, Yongjian Liu, Karen L Wooley
A zwitterionic polyphosphoester (zPPE), specifically l-cysteine-functionalized poly(but-3-yn-1-yloxy)-2-oxo-1,3,2-dioxaphospholane (zPBYP), has been developed as a poly(ethylene glycol) (PEG) alternative coating material for gold nanoparticles (AuNPs), the most extensively investigated metal nanoparticulate platform toward molecular imaging, photothermal therapy, and drug delivery applications. Thiol-yne conjugation of cysteine transformed an initial azido-terminated and alkynyl-functionalized PBYP homopolymer into zPBYP, offering hydrolytic degradability, biocompatibility, and versatile reactive moieties for installation of a range of functional groups...
October 22, 2018: Langmuir: the ACS Journal of Surfaces and Colloids
Thibaut Girardot, Céline Monard, Thomas Rimmelé
PURPOSE OF REVIEW: Choosing the best catheter for renal replacement therapy (RRT) is not an easy task. Beyond catheter length, many of its properties can influence effectiveness of the RRT session. Maintenance between sessions, particularly the locking solution, also impacts catheter lifespan and infection rates. RECENT FINDINGS: Many innovations in dialysis catheters have been proposed by the industry over the past decade, including the material used, the shape of the lumens and the position of the inflow and outflow holes...
December 2018: Current Opinion in Critical Care
Richard Paul Lion, Naile Tufan Pekkucuksen, Poyyapakkam Srivaths, Moreshwar S Desai, Ayse Akcan Arikan
AIMS: To establish the safety and efficacy of regional citrate anticoagulation (RCA) for pediatric liver failure (LF) patients receiving extracorporeal liver support (ELS) with albumin-assisted dialysis. METHODS: Retrospective review of pediatric LF patients receiving ELS from April 2014 to December 2016 at a tertiary children's hospital pediatric intensive care unit. Demographic and ELS data collected by chart review. Citrate accumulation (CA) was defined as total calcium (mmol/L): ionized calcium (mmol/L) > 2...
September 25, 2018: Blood Purification
Detlef Kindgen-Milles, Timo Brandenburger, Thomas Dimski
PURPOSE OF REVIEW: The delivery of an effective dialysis dose in continuous renal replacement therapy (CRRT) depends on adequate anticoagulation of the extracorporeal circuit. In most patients, either systemic heparin anticoagulation (SHA) or regional citrate anticoagulation (RCA) is used. This review will outline the basics and rationale of RCA and summarize data on safety and efficacy of both techniques. RECENT FINDINGS: The basic principle of RCA is to reduce the level of ionized calcium in the extracorporeal circuit via infusion of citrate...
December 2018: Current Opinion in Critical Care
Radomír Hyšpler, Alena Tichá, Roman Šafránek, Petr Moučka, Zora Nývltová, Karolína Štochlová, Sylvie Dusilová-Sulková, Zdeněk Zadák
Indoxyl sulfate has been identified as a major factor in the dysregulation of several genes. It is classified as a poorly dialyzable uremic toxin and thus a leading cause in the poor survival rate of dialysis patients. A monocentric, prospective, open cohort study was performed in 43 male patients undergoing chronic renal replacement therapy in a single hemodialysis center. The aim of the study was to determine the influence of acetate- versus citrate-buffered dialysis fluids in hemodialysis (HD) and postdilution hemodiafiltration (HDF) settings on the elimination of indoxyl sulfate...
2018: Disease Markers
Abdel Basset E Abdel Azim, Tamer W ElSaid, Heba W El Said, Walid Hemida, Salwa Zaghlool, Ahmed Ramadan, Zaghloul Gouda, Shereen El Masry, Wael Reda, Hala M Ali
BACKGROUND: Limited reports are available on the role of 4% citrate as a locking solution for temporary dialysis catheters. Hence, the aim of this study is to investigate the role of 4% citrate vs. heparin 5,000 µ/mL as a catheter-locking solution in a randomized controlled trial. MATERIALS AND METHODS: The trial was conducted in Egypt where the use of non-tunneled temporary catheters is prevalent compared to tunneled long-term catheters. The efficacy of catheter-locking solutions was compared regarding observation of rate of catheter dysfunction, low-flow pump, fever as a sign of central-line blood-stream infection (CLBSI), catheter-site infection, thrombosis, local bleeding, and systemic bleeding in each group of the study...
November 2018: Clinical Nephrology
Marinella Ruospo, Suetonia C Palmer, Patrizia Natale, Jonathan C Craig, Mariacristina Vecchio, Grahame J Elder, Giovanni Fm Strippoli
BACKGROUND: Phosphate binders are used to reduce positive phosphate balance and to lower serum phosphate levels for people with chronic kidney disease (CKD) with the aim to prevent progression of chronic kidney disease-mineral and bone disorder (CKD-MBD). This is an update of a review first published in 2011. OBJECTIVES: The aim of this review was to assess the benefits and harms of phosphate binders for people with CKD with particular reference to relevant biochemical end-points, musculoskeletal and cardiovascular morbidity, hospitalisation, and death...
August 22, 2018: Cochrane Database of Systematic Reviews
Gertrude J Nieuwenhuijs-Moeke, Tamar A J van den Berg, Stephan J L Bakker, Marius C van den Heuvel, Michel M R F Struys, Ton Lisman, Robert A Pol
To prevent renal graft thrombosis in kidney transplantation, centres use different perioperative anticoagulant strategies, based on various risk factors. In our centre, patients transplanted preemptively are considered at increased risk of renal graft thrombosis compared to patients who are dialysis-dependent at time of transplantation. Therefore these patients are given a single dose of 5000 IU unfractionated heparin intraoperatively before clamping of the vessels. We questioned whether there is a difference in haemostatic state between preemptively and non-preemptively transplanted patients and whether the distinction in intraoperative heparin administration used in our center is justified...
2018: PloS One
Nobuo Nagano, Ayako Minegishi, Kyoko Ito, Tetsuo Ando, Takaaki Tsutsui, Tetsuya Ogawa
Most patients undergoing dialysis are required to take many phosphate binder pills to control hyperphosphatemia. Phosphate binders prescribed in Japan are classified into two types: metal-based binders (Ca carbonate, lanthanum carbonate, ferric citrate hydrate, and sucroferric oxyhydroxide) and chemically synthesized polymers (sevelamer hydrochloride and bixalomer). The raw materials of metal-based phosphate binders are natural ores; thus, such binders may contain several other metallic elements. We measured the elemental contents in six metal-based phosphate binders using an inductively coupled plasma mass - spectrometry (ICP-MS) method...
July 10, 2018: Therapeutic Apheresis and Dialysis
S Shewdin, Y C Bong, S Okano, M D Chatfield, J Walsham
Traditionally heparin has been the anticoagulant of choice for venous dialysis catheter locking. There is systemic leakage of heparin catheter locking solutions at the time of injection. Alternative agents, such as citrate, are increasingly being used. We are not aware of any data in the critical care literature on the effect of citrate locking of venous dialysis catheters on systemic ionised calcium (iCa2+ ). To assess the effect of 4% citrate locking of venous dialysis catheters on systemic iCa2+ in intensive care patients we performed a prospective observational study of 50 paired samples in 26 intensive care patients receiving 4% citrate dialysis catheter locking in an adult tertiary intensive care unit between May 2016 and December 2016...
July 2018: Anaesthesia and Intensive Care
Peter A McCullough, Katrin Uhlig, John F Neylan, Pablo E Pergola, Steven Fishbane
Patients with chronic inflammatory conditions including chronic kidney disease (CKD) and heart failure (HF) are undertreated with iron-deficiency anemia (IDA). Progressive inflammation and reduced iron transport associated with CKD and HF may reduce the efficacy of oral iron therapy. Oral ferric citrate improves anemia markers in CKD, but its effects in patients with CKD and concomitant HF have not been described. Patients with CKD not on dialysis and IDA from a phase 2 and 3 trial were treated with ferric citrate (n = 190) or placebo (n = 188); patients with HF were identified from medical histories...
August 15, 2018: American Journal of Cardiology
Mark R Hanudel, Marciana Laster, Georgina Ramos, Barbara Gales, Isidro B Salusky
BACKGROUND: Ferric citrate, an iron-based phosphate binder, has been shown to improve both hyperphosphatemia and iron deficiency in adult chronic kidney disease patients, but its use in the pediatric dialysis population has not been described. METHODS: This is a retrospective analysis of 11 unselected pediatric dialysis patients who received ferric citrate as a phosphate binder between 2015 and 2017. Time-averaged laboratory values were compared pre- and post-ferric citrate initiation using the Wilcoxon signed-rank test...
November 2018: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
Jakob Gubensek, Karin Strobl, Stephan Harm, Rene Weiss, Tanja Eichhorn, Jadranka Buturovic-Ponikvar, Viktoria Weber, Jens Hartmann
BACKGROUND: Regional citrate anticoagulation has been associated with enhanced biocompatibility in hemodialysis, but the optimal dose of citrate remains to be established. Here, we compared parameters related to cellular activation during in vitro dialysis, using two doses of citrate. METHODS: Human whole blood, anticoagulated with either 3 mM or 4 mM of citrate, was recirculated in an in vitro miniaturized dialysis setup. Complement (C3a-desArg), soluble platelet factor 4 (PF4), thromboxane B2 (TXB2), myeloperoxidase (MPO), as well as platelet- and red blood cell-derived extracellular vesicles (EV) were quantified during recirculation...
2018: PloS One
Joana Gameiro, Sofia Jorge, José António Lopes
Heparin-induced thrombocytopenia (HIT) is a serious and life-threatening complication that occurs in five per cent of patients exposed to heparin. It should be considered in patients with a platelet count <100×109 cells/l or a >50% decrease from baseline count in association with heparin therapy. Thromboembolic complications develop in 50% of patients. Bleeding is rare as the platelet count nadir typically does not drop below 20×109 cells/l. Up to 12% of dialysis patients develop HIT, named haemodialysis-related-heparin-induced thrombocytopenia (HD-HIT), as they are a risk group with continuous exposure to heparin...
September 2018: Nefrología: Publicación Oficial de la Sociedad Española Nefrologia
Georg Lorenz, Christopher C Mayer, Quirin Bachmann, Sarah Stryeck, Matthias C Braunisch, Bernhard Haller, Javier Carbajo-Lozoya, Alina Schmidt, Simon Witthauer, Jasmin Abuzahu, Stephan Kemmner, Susanne Angermann, Naresh Koneru, Siegfried Wassertheurer, Richard Bieber, Uwe Heemann, Tobias Madl, Andreas Pasch, Christoph Schmaderer
Background: A novel in vitro test (T50 test) assesses ex vivo serum calcification propensity and predicts mortality in chronic kidney disease and haemodialysis (HD) patients. For the latter, a time-dependent decline of T50 was shown to relate to mortality. Here we assessed whether a 3-month switch to acetate-free, citrate-acidified, standard bicarbonate HD (CiaHD) sustainably improves calcification propensity. Methods: T50 values were assessed in paired midweek pre-dialysis sera collected before and 3 months after CiaHD in 78 prevalent European HD patients...
November 1, 2018: Nephrology, Dialysis, Transplantation
Yuanji Ma, Yan Xu, Fang Chen, Ying Wang, Lang Bai, Hong Tang
Aim: To assess the tolerance of citrate accumulation due to plasma exchange (PE) among patients with acute-on-chronic liver failure (ACLF). Methods: A prospective, observational study was conducted among patients with ACLF who received heparin anticoagulation during PE-centered therapy without filtration and dialysis. Citrate accumulation was defined as the value of total calcium (Catot ) to ionized calcium (Caion ) ratio (Catot /Caion ) greater than or equal to 2...
2018: Canadian Journal of Gastroenterology & Hepatology
M Schmitz, M Joannidis, D Czock, S John, A Jörres, S J Klein, M Oppert, V Schwenger, J Kielstein, A Zarbock, D Kindgen-Milles, C Willam
BACKGROUND: Regional citrate anticoagulation (RCA) in continuous renal replacement therapy can effectively anticoagulate dialysis circuits without having adverse effects on systemic heparin application. In particular, in continuous renal replacement therapy RCA is well established and represents a safe procedure with longer filter lifetimes and fewer bleeding complications. OBJECTIVES: To provide guidance on the indications, advantages and disadvantages, and use of RCA, current recommendations from the renal section of the DGIIN (Deutschen Gesellschaft für Internistische Intensivmedizin und Notfallmedizin), ÖGIAIN (Österreichischen Gesellschaft für Internistische und Allgemeine Intensivmedizin und Notfallmedizin) and DIVI (Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin) are stated...
June 2018: Medizinische Klinik, Intensivmedizin und Notfallmedizin
Raid Al Akeel, Ayesha Mateen, Khalid K Alharbi, Abdullah A Alyousef, Hazem M Al-Mandeel, Rabbani Syed
BACKGROUND: Cucumis sativus L. (cucumber), from the family Cucurbitaceae, is a therapeutic plant with various pharmacological benefits, broadly utilized as a part of complementary medicine (e.g., Unani, Ayurveda, Siddha, and Traditional Chinese). In light of past research discoveries, this plant had been chosen to consider its potential antibacterial action. METHODS: Extracts were purified by dialysis and ion exchange chromatography strategy and then assayed for antibacterial activity against four standard pathogenic bacterial strains known to cause foodborne infections and spoilage of food and herbal drugs...
April 3, 2018: BMC Complementary and Alternative Medicine
Ming Wen, Claudius Küchle, Dominik Steubl, Robin Satanovskji, Uwe Heemann, Yana Suttmann, Susanne Angermann, Stephan Kemmner, Lisa Rehbehn, Monika Huber, Christine Hauser, Christoph Schmaderer, Anna-Lena Reichelt, Bernhard Haller, Lutz Renders
BACKGROUND: The high cost, complexity of the available protocols, and metabolic complications are the major barriers that impede the clinical utilization of regional citrate anticoagulation (RCA) for sustained low efficiency dialysis (SLED) in critically ill patients. By comparing a novel protocol for SLED using 30% citrate solution with common protocol using unfractionated heparin, this study aimed to provide new insights for clinical applications of RCA. METHODS: In this retrospective study, a total of 282 critically ill patients who underwent SLED with citrate and/or heparin anticoagulation in six adult ICUs were enrolled...
April 3, 2018: BMC Nephrology
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