ArticleNephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association2009
Citrate pharmacokinetics and calcium levels during high-flux dialysis with regional citrate anticoagulation.
Article in Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 31 papers.
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Who cites it
31 citing papers in PubMed, 91 citations in OpenAlex.
- Calcium Mass Balance during Citrate Hemodialysis: A Randomized Controlled Trial Comparing Normal and Low Ionized Calcium Target Ranges.PloS one · 2016Trial
- Trial
- Post-dilution on line haemodiafiltration with citrate dialysate: first clinical experience in chronic dialysis patients.TheScientificWorldJournal · 2013Trial
- Implementation quality as a modifiable determinant of filter lifespan in regional citrate anticoagulation: a real-world clustering-adjusted study.Renal failure · 2026Article
- Regional citrate anticoagulation algorithm and management protocol aimed at ensuring blood calcium stability: a prospective single-arm study.Clinical kidney journal · 2025Article
- Switching from acetate to citrate dialysate in a central concentrate delivery system for high-volume online hemodiafiltration: a retrospective cohort study.Renal failure · 2024Article
- Deciphering simplified regional anticoagulation with citrate in intermittent hemodialysis: a clinical and computational study.Scientific reports · 2024Article
- Citrate anticoagulation and systemic heparin anticoagulation during continuous renal replacement therapy among critically-ill children.Pediatric research · 2024Article
- Toward acid- and heparin-free dialysis: the regional anticoagulation approach.Clinical kidney journal · 2024Article
- First In Vivo Applicational Data of Foam-Based Intrathoracic Chemotherapy (FBiTC) in a Swine Model.Pharmaceuticals (Basel, Switzerland) · 2023Article
- Drug Distribution and Penetration of Foam-Based Intraperitoneal Chemotherapy (FBIC).Pharmaceuticals (Basel, Switzerland) · 2023Article
- Use of regional citrate anticoagulation with medium cut-off membrane: pilot report.BMC nephrology · 2022Article
- COVID-19: the CaMKII-like system of S protein drives membrane fusion and induces syncytial multinucleated giant cells.Immunologic research · 2021Article
- An Observational Cohort Study of the 2-Month Use of Regional Citrate Anticoagulation in Maintenance Hemodialysis Patients with Cerebral Hemorrhage.Medical science monitor : international medical journal of experimental and clinical research · 2021Observational
- Simple citrate anticoagulation protocol for low flux haemodialysis.BMC nephrology · 2018Article
- Regional Citrate Anticoagulation for Intermittent Hemodialysis in Dogs.Journal of veterinary internal medicine · 2018Article
- Dialysis Procedures Alter Metabolic Conditions.Nutrients · 2017Review
- Regional citrate anticoagulation for continuous renal replacement therapy in children.Pediatric nephrology (Berlin, Germany) · 2017Observational
- A new prescription model for regional citrate anticoagulation in therapeutic plasma exchanges.BMC nephrology · 2017Article
- Insights about serum sodium behavior after 24 hours of continuous renal replacement therapy.Revista Brasileira de terapia intensiva · 2016Article
Corrections and comments
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Authors and funding
5 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundRegional citrate anticoagulation is a very effective anticoagulation method for haemodialysis. However, it is not widely used, primarily due to the risk of hypocalcaemia. We studied citrate and calcium kinetics to better understand safety aspects of this anticoagulation method.
methodsDuring 15 haemodialysis treatments with a calcium-free dialysis solution, citrate was infused pre-dialyser and calcium was substituted post-dialyser. Systemic and extracorporeal citrate and calcium concentrations were repeatedly measured to calculate citrate and calcium pharmacokinetics.
resultsRemoval by dialysis constituted the major elimination pathway of citrate (83 +/- 5%). Systemic citrate load and concentrations were low (17 +/- 7 mmol/4 h, 0.3 +/- 0.15 mmol/l). Combined use of calcium-free dialysate and citrate infusion increased diffusible calcium to 80% of total calcium and induced substantial dialytic loss of calcium (43 +/- 4 mmol/4 h). Since calcium was substituted, systemic calcium balances were positive (approximately +5 mmol) and concentrations stable. Calcium supplementation correlated with calcium dialytic losses, which in turn were dependent on total calcium and haematocrit.
conclusionsWhen using calcium-free dialysate during citrate anticoagulation, hypocalcaemia is very likely unless calcium is re-infused, because large amounts of calcium are lost in the dialysate. However, an accumulation of citrate in the patient's systemic circulation is an unlikely cause of hypocalcaemia since most of the citrate is removed by dialysis. Calcium substitution and monitoring are the most important safety measures. We propose a rational approach based on haematocrit and total calcium for the choice of the starting calcium supplementation rate.
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