title: Citrate anticoagulation control by ionized calcium levels does not prevent hemostasis and complement activation during hemodialysis.
abstract: The purpose of this study was to determine whether or not regional citrate anticoagulation (RCA) controlled by ionized calcium (iCa(2+)) would overcome thrombogenicity, prevent hemostasis, and complement activation during hemodialysis (HD). RCA was performed in 10 patients during 10 HD sessions using a polysulfone membrane in an effort to keep iCa(2+) at dialyzer outlet at < or =0.4 mmol/L. Compared to baseline, plasma levels of thrombin-antithrombin III complexes rose significantly at 240 min, and tissue factor and complement C5a component levels at 30 and 240 min of the procedure. Thrombocyte count declined significantly at 30 and 240 min, while activated clotting time (ACT) did not increase significantly, and platelet factor 4 as well as von Willebrand factor levels did not alter significantly. While ACT correlated significantly with some thrombogenicity markers, iCa(2+) did not correlate with ACT, changes in hemostasis, or C5a. We conclude the usually recommended iCa(2+) levels in the HD extracorporeal circuit did not guarantee the complete overcoming of thrombogenicity, prevention of hemostasis, and complement activation.
authors.affiliation: Department of Internal Medicine I, Charles University Medical School, Alej Svobody 80, 304-60 Pilsen, Czech Republic.
authors.forename: Karel
authors.initials: K
authors.lastname: Opatrný
authors.forename: Pavlína
authors.initials: P
authors.lastname: Richtrová
authors.forename: Kamila
authors.initials: K
authors.lastname: Polanská
authors.forename: Jan
authors.initials: J
authors.lastname: Wirth
authors.forename: Frantisek
authors.initials: F
authors.lastname: Sefrna
authors.forename: Martin
authors.initials: M
authors.lastname: Brandl
authors.forename: Dieter
authors.initials: D
authors.lastname: Falkenhagen
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000494:pharmacology*; D001777:Blood Coagulation / Q000187:drug effects; D002118:Calcium / Q000097:blood* / Q000627:therapeutic use; D002951:Citrates / Q000494:pharmacology*; D003167:Complement Activation / Q000187:drug effects*; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D015539:Platelet Activation / Q000187:drug effects; D006435:Renal Dialysis; D013927:Thrombosis / Q000517:prevention & control
chemical_list: D000925:Anticoagulants; D002951:Citrates; C514290:trisodium citrate; D002118:Calcium