Quantification of systemic delivery of substrates for intermediate metabolism during citrate anticoagulation of continuous renal replacement therapy.
BACKGROUND
There are limited data on systemic delivery of metabolic substrates during citrate anticoagulation. The direct citrate measurements are usually not available.


METHODS
Patients on 2.2% acid-citrate-dextrose (ACD, n = 41) were compared to a control group on unfractionated heparin (n = 17). All were treated on 1.9-m(2) polysulfone filters. Samples were taken from the central venous catheter, ports pre- and post-filter and from effluent.


RESULTS
The gain of citrate in CVVH (n = 18) was not different from CVVHDF (n = 23, p = 0.8). Mean gain of citrate was 25.4 ± 6.4 mmol/h. The systemic loads of lactate (p = 0.12) and glucose (p = 0.23) in CVVH were similar to CVVHDF. Mean inputs of lactate and glucose were 62.9 ± 21.1 and 26.6 ± 10.4 mmol/h, respectively. The mean difference between post- and prefilter unmeasured anions (d-UA) correlated with mean difference of citrate concentrations (p < 0.0001, r(2) = 0.66). The estimated caloric load of the citrate modalities was 5,536 ± 1,385 kJ/ 24 h.


CONCLUSIONS
ACD might represent a significant load of metabolic substrates, particularly if used with lactate buffer. Systemic delivery of citrate can be predicted using d-UA in the extracorporeal circuit.
Department of Anesthesiology and Intensive Care, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic. martin.balik@post.cz
Martin
M
Balik
Mykhaylo
M
Zakharchenko
Michal
M
Otahal
Jan
J
Hruby
Ferdinand
F
Polak
Katerina
K
Rusinova
Zdenek
Z
Stach
Jaroslava
J
Vavrova
Antonin
A
Jabor
D058186:Acute Kidney Injury / Q000628:therapy*; D000925:Anticoagulants / Q000378:metabolism / Q000627:therapeutic use*; D019343:Citric Acid / Q000378:metabolism / Q000627:therapeutic use*; D004867:Equipment Design; D005947:Glucose / Q000031:analogs & derivatives* / Q000378:metabolism / Q000627:therapeutic use; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D019344:Lactic Acid / Q000378:metabolism; D011446:Prospective Studies; D017582:Renal Replacement Therapy / Q000295:instrumentation / Q000379:methods*
D000925:Anticoagulants; C002113:acid citrate dextrose; D019343:Citric Acid; D019344:Lactic Acid; D006493:Heparin; D005947:Glucose