An observational study on the effects of nadroparin-based and citrate-based continuous venovenous hemofiltration on calcium metabolism.
BACKGROUND
To study calcium homeostasis during citrate-based compared to nadroparin-based CVVH in critically-ill patients with acute renal failure.


METHODS
11 patients were observed during citrate anticoagulation, 9 with nadroparin and 10 controls. Citrate was chosen for patients with active or at risk for bleeding.


RESULTS
The controls had, at 24 h, a median serum iCa of 1.1 mmol/l, the citrate group 0.87 mmol/l and the nadroparin group 1.1 mmol/l (citrate vs. control p = 0.001, citrate vs. nadroparin p = 0.002). At 48 h, iCa was not significantly different anymore. Ca balance was negative for the citrate group in contrast to the nadroparin group (p = 0.012). Median serum PTH was higher (30.0 pmol/l vs. 6.5 pmol/l, p = 0.003) in the citrate group.


CONCLUSIONS
With a relative low target-serum-iCa (0.8-0.9 mmol/l) citrate CVVH-treated patients had a negative daily calcium balance and a temporarily lower iCa level resulting in an enhanced PTH response in comparison to nadroparin.
van der Voort
Peter H J
PH
Department of Intensive Care, Medical Centre Leeuwarden, Leeuwarden, The Netherlands. phjvdvoort@chello.nl
Postma
Sonja R
SR
Kingma
W Peter
WP
Boerma
E Christiaan
EC
de Heide
Loek J M
LJ
Bakker
Andries J
AJ
D058186:Acute Kidney Injury / Q000097:blood / Q000628:therapy*; D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D002118:Calcium / Q000008:administration & dosage / Q000097:blood* / Q000493:pharmacokinetics / Q000627:therapeutic use; D019355:Calcium Citrate / Q000378:metabolism; D002614:Chelating Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002951:Citrates / Q000009:adverse effects* / Q000627:therapeutic use; D003422:Critical Care / Q000379:methods; D016638:Critical Illness / Q000628:therapy; D005260:Female; D006440:Hemofiltration / Q000379:methods*; D006470:Hemorrhage / Q000139:chemically induced / Q000517:prevention & control; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000097:blood / Q000139:chemically induced*; D006996:Hypocalcemia / Q000139:chemically induced / Q000209:etiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D017762:Nadroparin / Q000009:adverse effects / Q000627:therapeutic use*; D010281:Parathyroid Hormone / Q000097:blood; D011446:Prospective Studies; D000077559:Sodium Citrate; D014807:Vitamin D / Q000031:analogs & derivatives / Q000097:blood
D000925:Anticoagulants; D002614:Chelating Agents; D002951:Citrates; D017762:Nadroparin; D010281:Parathyroid Hormone; D014807:Vitamin D; D000077559:Sodium Citrate; C104450:25-hydroxyvitamin D; D019355:Calcium Citrate; D002118:Calcium