Citrate Pharmacokinetics in Critically Ill Patients with Acute Kidney Injury
Open Access
- 18 June 2013
- journal article
- research article
- Published by Public Library of Science (PLoS) in PLOS ONE
- Vol. 8 (6), e65992
- https://doi.org/10.1371/journal.pone.0065992
Abstract
Regional citrate anticoagulation (RCA) is gaining popularity in continous renal replacement therapy (CRRT) for critically ill patients. The risk of citrate toxicity is a primary concern during the prolonged process. The aim of this study was to assess the pharmacokinetics of citrate in critically ill patients with AKI, and used the kinetic parameters to predict the risk of citrate accumulation in this population group undergoing continuous veno-venous hemofiltration (CVVH) with RCA. Critically ill patients with AKI (n = 12) and healthy volunteers (n = 12) were investigated during infusing comparative dosage of citrate. Serial blood samples were taken before, during 120 min and up to 120 min after infusion. Citrate pharmacokinetics were calculated and compared between groups. Then the estimated kinetic parameters were applied to the citrate kinetic equation for validation in other ten patients’ CVVH sessions with citrate anticoagulation. Total body clearance of citrate was similar in critically ill patients with AKI and healthy volunteers (648.04±347.00 L/min versus 686.64±353.60 L/min; P = 0.624). Basal and peak citrate concentrations were similar in both groups (p = 0.423 and 0.247, respectively). The predicted citrate curve showed excellent fit to the measurements. Citrate clearance is not impaired in critically ill patients with AKI in the absence of severe liver dysfunction. Citrate pharmacokinetic data can provide a basis for the clinical use of predicting the risk of citrate accumulation. ClinicalTrials.gov Identifier NCT00948558This publication has 21 references indexed in Scilit:
- A safe citrate anticoagulation protocol with variable treatment efficacy and excellent control of the acid–base status*Critical Care Medicine, 2009
- Citrate pharmacokinetics and calcium levels during high-flux dialysis with regional citrate anticoagulationNephrology Dialysis Transplantation, 2009
- Citrate anticoagulation for continuous venovenous hemofiltration*Critical Care Medicine, 2009
- The use of regional citrate anticoagulation for continuous venovenous hemodiafiltration in acute kidney injuryCritical Care Medicine, 2008
- Citrate Kinetics in Patients Receiving Long-Term Hemodialysis TherapyAmerican Journal of Kidney Diseases, 2005
- Citrate pharmacokinetics and metabolism in cirrhotic and noncirrhotic critically ill patientsCritical Care Medicine, 2003
- Pharmacokinetic principles during continuous renal replacement therapy: Drugs and dosageKidney International, 1999
- Effect of anticoagulation on blood membrane interactions during hemodialysisKidney International, 1999
- The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failureIntensive Care Medicine, 1996
- III. THE FATE OF CITRATE IN ERYTHROBLASTOTIC INFANTS TREATED WITH EXCHANGE TRANSFUSION 12JCI Insight, 1949