Evidence map›Paper›PMID 28249613›Full record

ArticleBMC nephrology2017

A new prescription model for regional citrate anticoagulation in therapeutic plasma exchanges.

Sébastien Kissling, Cécile Legallais, Menno Pruijm, Daniel Teta, Bruno Vogt, Michel Burnier, Eric Rondeau, Christophe Ridel

Erratum issuedOpen access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC nephrology, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 10 papers.

0numbers the graph read from it
0cells of the map it votes in
10citing papers in PubMed
0.5field-weighted citation impact, top 36% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

10 citing papers in PubMed, 17 citations in OpenAlex.

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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

8 authors at 4 institutions in 2 countries.

Sébastien KisslingService d'Urgences néphrologiques et Transplantation rénale (UNTR), Hôpital Tenon, Paris, 75020, France. sebastien.kissling@chuv.ch.ORCID 0000-0001-7682-3896
Cécile LegallaisBiomécanique et Bioingénierie, Université de Technologie de Compiègne (UTC), UMR CNRS 7338, Compiègne, 60203, France.
Menno PruijmService de Néphrologie et Hypertension, Centre Hospitalier Universitaire Vaudois (CHUV), Rte du Bugnon 17, 1011, Lausanne, CH, Switzerland.
Daniel TetaService de Néphrologie et Hypertension, Centre Hospitalier Universitaire Vaudois (CHUV), Rte du Bugnon 17, 1011, Lausanne, CH, Switzerland.
Bruno VogtService de Néphrologie et Hypertension, Centre Hospitalier Universitaire Vaudois (CHUV), Rte du Bugnon 17, 1011, Lausanne, CH, Switzerland.
Michel BurnierService de Néphrologie et Hypertension, Centre Hospitalier Universitaire Vaudois (CHUV), Rte du Bugnon 17, 1011, Lausanne, CH, Switzerland.
Eric RondeauService d'Urgences néphrologiques et Transplantation rénale (UNTR), Hôpital Tenon, Paris, 75020, France.
Christophe RidelService d'Urgences néphrologiques et Transplantation rénale (UNTR), Hôpital Tenon, Paris, 75020, France.
University Hospital of Lausanne · CHSorbonne Université · FRCentre National de la Recherche Scientifique · FRUniversité de Technologie de Compiègne · FR

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundRegional citrate anticoagulation (RCA) is proposed for various extracorporeal purification techniques to overcome the risk of bleeding that might result from systemic anticoagulation. Yet, no individualized treatment protocol has been proposed for therapeutic plasma exchange (TPE) so far. The objective of this study was to assess the determinants of blood citrate concentration needed and to develop an individualized RCA protocol useful for clinical practice.

methodsThe study population included 14 patients who underwent a total of 47 TPE sessions. Citrate was infused pre-plasmafilter. Post-plasmafilter and systemic plasma ionized calcium concentrations were measured at standardized time intervals. An algorithm was proposed for the supplementation of calcium. During the discovery phase, citrate was infused at a fixed starting rate, and adapted accordingly to obtained post-plasmafilter ionized calcium levels. Using a mathematical approach, an algorithm was thereafter developed for individualized prescriptions of citrate.

resultsPre-treatment values of hematocrit and plasma ionized calcium were the main determinants of the required rate of citrate infusion. These can be integrated into a final equation enabling to individualize the prescription. A prefilter ionized calcium concentration between 0.24 and 0.33 mmol/l prevented coagulation of the extracorporeal circuit. Significant hypocalcemia occurred in 8.5% of treatments. There were no significant acid-base disturbances.

conclusionWe propose a new protocol, which enables for the first time to individualize the prescription of regional citrate anticoagulation during TPE, in an efficient manner. The immediately obtained regional anticoagulation protects against both the risk of coagulation of the membrane and the exposure to an excess of citrate.

Indexed as

AdultAgedAlgorithmsAnticoagulantsAnti-Neutrophil Cytoplasmic Antibody-Associated VasculitisCalciumCitric AcidClinical ProtocolsFemaleGraft RejectionHemorrhageHumansMaleMiddle AgedPlasma ExchangeThrombotic MicroangiopathiesAnticoagulantsCalciumCitric AcidCitrateClinical protocolDrug prescriptionMathematical modelPlasma exchanges

Identifiers

PMID28249613
PMCPMC5333425
OpenAlexW2592258463

What OpenQuestion holds

Textmetadata
LicenceCC BY
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.