title: CRRT Regional Anticoagulation Using Citrate in the Liver Failure and Liver Transplant Population.
abstract: Regional citrate for continuous renal replacement therapy (CRRT) use in patients with liver failure or post-liver transplant has been considered a contraindication because of the risk of citrate toxicity development. Regional citrate has the benefit of decreased bleeding risks over systemic anticoagulation; therefore, it is of great benefit to the coagulopathic and surgical populations. This article analyzes current empiric data and compares with a case study specifically related to liver failure, liver transplant, and CRRT use. We found that the use of a total serum to ionized calcium ratio was much more reliable in measuring liver function than liver enzyme figures. This when paired with a citrate-reduction guideline based on serum to ionized calcium ratios provided effective, early management of citrate toxicity. Using new measurements to calculate liver metabolism of citrate and using a new citrate-reducing guideline allow the bedside practitioner to use regional citrate anticoagulation in patients with liver failure and liver transplant who require CRRT.
authors.affiliation: Surgical Intensive Care Unit (Mr Wonnacott), Cardiovascular Intensive Care Unit, Samuel and Jean Frankel Cardiovascular Center (Ms Josephs), and Acute/Nocturnal Hemodialysis Interventional Nephrology Unit (Ms Jamieson), University of Michigan Health Systems, Ann Arbor.
authors.forename: Rob
authors.initials: R
authors.lastname: Wonnacott
authors.forename: Brandi
authors.initials: B
authors.lastname: Josephs
authors.forename: Jill
authors.initials: J
authors.lastname: Jamieson
mesh_terms: D058186:Acute Kidney Injury / Q000628:therapy; D000925:Anticoagulants / Q000627:therapeutic use*; D019343:Citric Acid / Q000627:therapeutic use* / Q000633:toxicity; D006470:Hemorrhage / Q000517:prevention & control; D006801:Humans; D017093:Liver Failure / Q000188:drug therapy*; D016031:Liver Transplantation; D017582:Renal Replacement Therapy / Q000379:methods*
chemical_list: D000925:Anticoagulants; D019343:Citric Acid