Citrate Toxicity, Continuous Renal Replacement Therapy, Liver Failure, Acute, Liver Failure, Acute on Chronic, Pharmacokinetic, Regional Citrate Anticoagulation
Conditions
Keywords
Regional citrate anticoagulation, Liver failure, Pharmacokinetics, CRRT, Cirrhosis
Brief summary
Citrate has been proposed as anticoagulation of choice in continuous renal replacement therapy (CRRT). However, little is known about the pharmacokinetics (PKs) and metabolism of citrate in liver failure patients who require CRRT with regional citrate anticoagulation (RCA).
Detailed description
This study aimed to evaluate citrate PKs, metabolic complications, and clinical outcomes among critically ill acute liver failure (ALF) and acute on top chronic liver failure (ACLF) patients receiving CRRT.
Interventions
DIAGNOSTIC_TESTPharmacokinetic study
* Start CVVH session with isotonic citrate solution (13.3 mmol/L) as predilution, targeting citrate dose at 3 mmol/L * Blood samples collection at pre-filter for citrate concentration, blood gas, electrolyte and ionized calcium and magnesium * In addition, 10 minutes after the end of citrate infusion, blood samples were taken simultaneously from both pre-filter and post-filter to calculate citrate clearance by filter
Sponsors
Chulalongkorn University
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
DIAGNOSTIC
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Critically ill ALF or ACLF adult patients with AKI * aged ≥ 18 y old * Currently receiving CRRT.
Exclusion criteria
* severe acidosis (pH \< 7.1) or severe alkalosis (pH \> 7.55) * blood transfusion within 24 h prior to the study * use of citrate-containing medications * severe hypocalcemia (serum ionized calcium \< 0.8 mmol/L) * use of heparin as anticoagulation
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Citrate clearance | 4 hours | Citrate clearance by body |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Citrate accumulation | 4 hours | Number of total calcium to ionized calcium ratio \> 2.5 with acidosis with hypocalcemia |
| Tmax | 2 hours | Time to maximum concentration of citrate at 2 hours |
| Area under the time curve | 4 hours | Area under the plasma concentration-time curve of citrate |
| Ratio of total calcium to systemic ionized calcium | 4 hours | Number of patients with total calcium to systemic ionized calcium \> 2.5 with or without metabolic acidosis |
| Change of ionized magnesium | 4 hours | Change in systemic ionized magnesium in arterial blood gas during study |
| Change of bicarbonate | 4 hours | Change of bicarbonate in arterial blood gas during study |
| Change of systemic ionized calcium | 4 hours | Change in systemic ionized calcium in arterial blood gas during study |
Countries
Thailand
Outcome results
None listed