Incidence and outcome of metabolic disarrangements consistent with citrate accumulation in critically ill patients undergoing continuous venovenous hemodialysis with regional citrate anticoagulation
Abstract Background Systemic citrate accumulation is a complication of regional citrate anticoagulation (RCA) during continuous renal replacement therapy (CRRT). Our objective was to determine the incidence of clinical signs consistent with citrate accumulation in a large and representative cohort o...
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| Veröffentlicht in: | Journal of critical care 2014-04, Vol.29 (2), p.265-271 |
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| creator | Khadzhynov, Dmytro, MD Schelter, Christin Lieker, Ina, MD Mika, Alice Staeck, Oliver, MD Neumayer, Hans.-H., MD Peters, Harm, MD Slowinski, Torsten, MD |
| description | Abstract Background Systemic citrate accumulation is a complication of regional citrate anticoagulation (RCA) during continuous renal replacement therapy (CRRT). Our objective was to determine the incidence of clinical signs consistent with citrate accumulation in a large and representative cohort of intensive care unit patients undergoing RCA-CRRT. Methods Patients treated with RCA-CRRT during 2008-2010 were retrospectively analyzed. Decreased systemic ionized calcium (iCa), increased demand for calcium substitution, elevated total calcium to iCa ratio, and metabolic acidosis were evaluated as indicators for citrate accumulation. Results In the 3-year period, 1070 patients were treated with RCA–continuous venovenous hemodialysis. Metabolic signs of citrate accumulation occurred in 32 patients (2.99%, 64.5±14.0 years, 65.6% male, Acute Physiology and Chronic Health Evaluation score 34.2±9.7): systemic iCa decreased to 1.01±0.10 mmol/L with a simultaneous increase of the calcium substitution rate to 129%±26%, and the mean total calcium to iCa ratio increased to 2.51±0.54. All 32 patients had therapy-resistant shock with severe lactic acidosis (pH 7.20±0.11, lactate 136±61 mg/dL), indicating severe intracellular hypoxia. None of the patients survived. Conclusions The incidence of disarrangements consistent with citrate accumulation in patients undergoing RCA–continuous venovenous hemodialysis was low, taking place exclusively in patients with severe lactic acidosis due to multiorgan failure. This suggests that the appearance of citrate accumulation is secondary to a severe failure of cellular respiration. |
| doi_str_mv | 10.1016/j.jcrc.2013.10.015 |
| format | Article |
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Our objective was to determine the incidence of clinical signs consistent with citrate accumulation in a large and representative cohort of intensive care unit patients undergoing RCA-CRRT. Methods Patients treated with RCA-CRRT during 2008-2010 were retrospectively analyzed. Decreased systemic ionized calcium (iCa), increased demand for calcium substitution, elevated total calcium to iCa ratio, and metabolic acidosis were evaluated as indicators for citrate accumulation. Results In the 3-year period, 1070 patients were treated with RCA–continuous venovenous hemodialysis. Metabolic signs of citrate accumulation occurred in 32 patients (2.99%, 64.5±14.0 years, 65.6% male, Acute Physiology and Chronic Health Evaluation score 34.2±9.7): systemic iCa decreased to 1.01±0.10 mmol/L with a simultaneous increase of the calcium substitution rate to 129%±26%, and the mean total calcium to iCa ratio increased to 2.51±0.54. All 32 patients had therapy-resistant shock with severe lactic acidosis (pH 7.20±0.11, lactate 136±61 mg/dL), indicating severe intracellular hypoxia. None of the patients survived. Conclusions The incidence of disarrangements consistent with citrate accumulation in patients undergoing RCA–continuous venovenous hemodialysis was low, taking place exclusively in patients with severe lactic acidosis due to multiorgan failure. This suggests that the appearance of citrate accumulation is secondary to a severe failure of cellular respiration.</description><identifier>ISSN: 0883-9441</identifier><identifier>EISSN: 1557-8615</identifier><identifier>DOI: 10.1016/j.jcrc.2013.10.015</identifier><identifier>PMID: 24360392</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Acute Kidney Injury - blood ; Acute Kidney Injury - therapy ; Acute renal injury ; Aged ; Anticoagulants - adverse effects ; Calcium - blood ; Citrate accumulation ; Citrate anticoagulation ; Citrates - adverse effects ; Citrates - blood ; Citric Acid ; Continuous renal replacement therapy ; Continuous venovenous hemodialysis ; Critical Care ; Critical Illness ; Female ; Hemodialysis ; Humans ; Incidence ; Intensive care ; Lactate acidosis ; Male ; Metabolic Diseases - blood ; Metabolic disorders ; Middle Aged ; Patients ; Renal Replacement Therapy - adverse effects ; Renal Replacement Therapy - methods ; Retrospective Studies</subject><ispartof>Journal of critical care, 2014-04, Vol.29 (2), p.265-271</ispartof><rights>Elsevier Inc.</rights><rights>2014 Elsevier Inc.</rights><rights>Copyright © 2014 Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited Apr 2014</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c439t-422e43761331b446d372b0acdf0053724e4137c4e2bc6f966339afa535a72fa13</citedby><cites>FETCH-LOGICAL-c439t-422e43761331b446d372b0acdf0053724e4137c4e2bc6f966339afa535a72fa13</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S088394411300395X$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24360392$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Khadzhynov, Dmytro, MD</creatorcontrib><creatorcontrib>Schelter, Christin</creatorcontrib><creatorcontrib>Lieker, Ina, MD</creatorcontrib><creatorcontrib>Mika, Alice</creatorcontrib><creatorcontrib>Staeck, Oliver, MD</creatorcontrib><creatorcontrib>Neumayer, Hans.-H., MD</creatorcontrib><creatorcontrib>Peters, Harm, MD</creatorcontrib><creatorcontrib>Slowinski, Torsten, MD</creatorcontrib><title>Incidence and outcome of metabolic disarrangements consistent with citrate accumulation in critically ill patients undergoing continuous venovenous hemodialysis with regional citrate anticoagulation</title><title>Journal of critical care</title><addtitle>J Crit Care</addtitle><description>Abstract Background Systemic citrate accumulation is a complication of regional citrate anticoagulation (RCA) during continuous renal replacement therapy (CRRT). Our objective was to determine the incidence of clinical signs consistent with citrate accumulation in a large and representative cohort of intensive care unit patients undergoing RCA-CRRT. Methods Patients treated with RCA-CRRT during 2008-2010 were retrospectively analyzed. Decreased systemic ionized calcium (iCa), increased demand for calcium substitution, elevated total calcium to iCa ratio, and metabolic acidosis were evaluated as indicators for citrate accumulation. Results In the 3-year period, 1070 patients were treated with RCA–continuous venovenous hemodialysis. Metabolic signs of citrate accumulation occurred in 32 patients (2.99%, 64.5±14.0 years, 65.6% male, Acute Physiology and Chronic Health Evaluation score 34.2±9.7): systemic iCa decreased to 1.01±0.10 mmol/L with a simultaneous increase of the calcium substitution rate to 129%±26%, and the mean total calcium to iCa ratio increased to 2.51±0.54. All 32 patients had therapy-resistant shock with severe lactic acidosis (pH 7.20±0.11, lactate 136±61 mg/dL), indicating severe intracellular hypoxia. None of the patients survived. Conclusions The incidence of disarrangements consistent with citrate accumulation in patients undergoing RCA–continuous venovenous hemodialysis was low, taking place exclusively in patients with severe lactic acidosis due to multiorgan failure. This suggests that the appearance of citrate accumulation is secondary to a severe failure of cellular respiration.</description><subject>Acute Kidney Injury - blood</subject><subject>Acute Kidney Injury - therapy</subject><subject>Acute renal injury</subject><subject>Aged</subject><subject>Anticoagulants - adverse effects</subject><subject>Calcium - blood</subject><subject>Citrate accumulation</subject><subject>Citrate anticoagulation</subject><subject>Citrates - adverse effects</subject><subject>Citrates - blood</subject><subject>Citric Acid</subject><subject>Continuous renal replacement therapy</subject><subject>Continuous venovenous hemodialysis</subject><subject>Critical Care</subject><subject>Critical Illness</subject><subject>Female</subject><subject>Hemodialysis</subject><subject>Humans</subject><subject>Incidence</subject><subject>Intensive care</subject><subject>Lactate acidosis</subject><subject>Male</subject><subject>Metabolic Diseases - blood</subject><subject>Metabolic disorders</subject><subject>Middle Aged</subject><subject>Patients</subject><subject>Renal Replacement Therapy - adverse effects</subject><subject>Renal Replacement Therapy - methods</subject><subject>Retrospective Studies</subject><issn>0883-9441</issn><issn>1557-8615</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9UsuKFDEULURx2tEfcCEBN266zbOqC0QYBh8DAy5UcBfSt271pE0lbZIa6R_0u0zs1oFZuAi53JxHbk6a5jmjK0ZZ-3q32kGEFadMlMaKMvWgWTCluuW6Zephs6DrtVj2UrKz5klKO0pZJ4R63JxxKVoqer5ofl15sAN6QGL8QMKcIUxIwkgmzGYTnAUy2GRiNH6LE_qcCASfbMqlJj9tviFgczS5CADM0-xMtsET6wlEmy0Y5w7EOkf25eAPf_YDxm2wflulsvVzmBO5RR_qKuUNTmGwxh2KzdEi4raIGnfnVXgQzPZk97R5NBqX8NlpP2--vn_35fLj8vrTh6vLi-slSNHnpeQcpehaJgTbSNkOouMbamAYKVWlliiZ6EAi30A79m0rRG9Go4QyHR8NE-fNq6PuPoYfM6asJ5sAnTMey801U1SytqOyLdCX96C7MMcyQ0Ux3jHVd7Sg-BEFMaQUcdT7aCcTD5pRXVPWO11T1jXl2ispF9KLk_S8mXD4R_kbawG8OQKwvMWtxagT2BryYCNC1kOw_9d_e48Ozvoa5Xc8YLqbQyeuqf5c_1n9ZkzQYq--id8TqtOR</recordid><startdate>201404</startdate><enddate>201404</enddate><creator>Khadzhynov, Dmytro, MD</creator><creator>Schelter, Christin</creator><creator>Lieker, Ina, MD</creator><creator>Mika, Alice</creator><creator>Staeck, Oliver, MD</creator><creator>Neumayer, Hans.-H., MD</creator><creator>Peters, Harm, MD</creator><creator>Slowinski, Torsten, MD</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>ASE</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FPQ</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K6X</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>201404</creationdate><title>Incidence and outcome of metabolic disarrangements consistent with citrate accumulation in critically ill patients undergoing continuous venovenous hemodialysis with regional citrate anticoagulation</title><author>Khadzhynov, Dmytro, MD ; Schelter, Christin ; Lieker, Ina, MD ; Mika, Alice ; Staeck, Oliver, MD ; Neumayer, Hans.-H., MD ; Peters, Harm, MD ; Slowinski, Torsten, MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c439t-422e43761331b446d372b0acdf0053724e4137c4e2bc6f966339afa535a72fa13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Acute Kidney Injury - blood</topic><topic>Acute Kidney Injury - therapy</topic><topic>Acute renal injury</topic><topic>Aged</topic><topic>Anticoagulants - adverse effects</topic><topic>Calcium - blood</topic><topic>Citrate accumulation</topic><topic>Citrate anticoagulation</topic><topic>Citrates - adverse effects</topic><topic>Citrates - blood</topic><topic>Citric Acid</topic><topic>Continuous renal replacement therapy</topic><topic>Continuous venovenous hemodialysis</topic><topic>Critical Care</topic><topic>Critical Illness</topic><topic>Female</topic><topic>Hemodialysis</topic><topic>Humans</topic><topic>Incidence</topic><topic>Intensive care</topic><topic>Lactate acidosis</topic><topic>Male</topic><topic>Metabolic Diseases - blood</topic><topic>Metabolic disorders</topic><topic>Middle Aged</topic><topic>Patients</topic><topic>Renal Replacement Therapy - adverse effects</topic><topic>Renal Replacement Therapy - methods</topic><topic>Retrospective Studies</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Khadzhynov, Dmytro, MD</creatorcontrib><creatorcontrib>Schelter, Christin</creatorcontrib><creatorcontrib>Lieker, Ina, MD</creatorcontrib><creatorcontrib>Mika, Alice</creatorcontrib><creatorcontrib>Staeck, Oliver, MD</creatorcontrib><creatorcontrib>Neumayer, Hans.-H., MD</creatorcontrib><creatorcontrib>Peters, Harm, MD</creatorcontrib><creatorcontrib>Slowinski, Torsten, MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Proquest Nursing & Allied Health Source</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>British Nursing Index</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>British Nursing Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of critical care</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Khadzhynov, Dmytro, MD</au><au>Schelter, Christin</au><au>Lieker, Ina, MD</au><au>Mika, Alice</au><au>Staeck, Oliver, MD</au><au>Neumayer, Hans.-H., MD</au><au>Peters, Harm, MD</au><au>Slowinski, Torsten, MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Incidence and outcome of metabolic disarrangements consistent with citrate accumulation in critically ill patients undergoing continuous venovenous hemodialysis with regional citrate anticoagulation</atitle><jtitle>Journal of critical care</jtitle><addtitle>J Crit Care</addtitle><date>2014-04</date><risdate>2014</risdate><volume>29</volume><issue>2</issue><spage>265</spage><epage>271</epage><pages>265-271</pages><issn>0883-9441</issn><eissn>1557-8615</eissn><abstract>Abstract Background Systemic citrate accumulation is a complication of regional citrate anticoagulation (RCA) during continuous renal replacement therapy (CRRT). Our objective was to determine the incidence of clinical signs consistent with citrate accumulation in a large and representative cohort of intensive care unit patients undergoing RCA-CRRT. Methods Patients treated with RCA-CRRT during 2008-2010 were retrospectively analyzed. Decreased systemic ionized calcium (iCa), increased demand for calcium substitution, elevated total calcium to iCa ratio, and metabolic acidosis were evaluated as indicators for citrate accumulation. Results In the 3-year period, 1070 patients were treated with RCA–continuous venovenous hemodialysis. Metabolic signs of citrate accumulation occurred in 32 patients (2.99%, 64.5±14.0 years, 65.6% male, Acute Physiology and Chronic Health Evaluation score 34.2±9.7): systemic iCa decreased to 1.01±0.10 mmol/L with a simultaneous increase of the calcium substitution rate to 129%±26%, and the mean total calcium to iCa ratio increased to 2.51±0.54. All 32 patients had therapy-resistant shock with severe lactic acidosis (pH 7.20±0.11, lactate 136±61 mg/dL), indicating severe intracellular hypoxia. None of the patients survived. Conclusions The incidence of disarrangements consistent with citrate accumulation in patients undergoing RCA–continuous venovenous hemodialysis was low, taking place exclusively in patients with severe lactic acidosis due to multiorgan failure. This suggests that the appearance of citrate accumulation is secondary to a severe failure of cellular respiration.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>24360392</pmid><doi>10.1016/j.jcrc.2013.10.015</doi><tpages>7</tpages></addata></record> |
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| subjects | Acute Kidney Injury - blood Acute Kidney Injury - therapy Acute renal injury Aged Anticoagulants - adverse effects Calcium - blood Citrate accumulation Citrate anticoagulation Citrates - adverse effects Citrates - blood Citric Acid Continuous renal replacement therapy Continuous venovenous hemodialysis Critical Care Critical Illness Female Hemodialysis Humans Incidence Intensive care Lactate acidosis Male Metabolic Diseases - blood Metabolic disorders Middle Aged Patients Renal Replacement Therapy - adverse effects Renal Replacement Therapy - methods Retrospective Studies |
| title | Incidence and outcome of metabolic disarrangements consistent with citrate accumulation in critically ill patients undergoing continuous venovenous hemodialysis with regional citrate anticoagulation |
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