Hypercitratemia is a mortality predictor among patients on continuous venovenous hemodiafiltration and regional citrate anticoagulation.

Autor: Dos Santos TOC; Nephrology Division, Universidade Federal de São Paulo, Rua Botucatu, 740, São Paulo, SP, 04023-062, Brazil.; School of Medicine, Universidade de Pernambuco, Recife, PE, Brazil., Dos Santos Ferreira CE; Clinical Laboratory, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., Mangueira CLP; Clinical Laboratory, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., Ammirati AL; Nephrology Division, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.; Dialysis Center, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., Scherer PF; Nephrology Division, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.; Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., Doher MP; Nephrology Division, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., Matsui TN; Nephrology Division, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.; Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., Dos Santos BFC; Nephrology Division, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.; Dialysis Center, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., Pereira VG Jr; Nephrology Division, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., Batista MC; Nephrology Division, Universidade Federal de São Paulo, Rua Botucatu, 740, São Paulo, SP, 04023-062, Brazil.; Nephrology Division, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., Monte JCM; Nephrology Division, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.; School of Medicine, Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, SP, Brazil., Santos OFP; Nephrology Division, Universidade Federal de São Paulo, Rua Botucatu, 740, São Paulo, SP, 04023-062, Brazil.; Nephrology Division, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., de Souza Durão M Jr; Nephrology Division, Universidade Federal de São Paulo, Rua Botucatu, 740, São Paulo, SP, 04023-062, Brazil. marcelino.durao@unifesp.br.; Nephrology Division, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil. marcelino.durao@unifesp.br.; School of Medicine, Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, SP, Brazil. marcelino.durao@unifesp.br.; Kidney Transplant Unit, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil. marcelino.durao@unifesp.br.
Jazyk: angličtina
Zdroj: Scientific reports [Sci Rep] 2023 Nov 17; Vol. 13 (1), pp. 20176. Date of Electronic Publication: 2023 Nov 17.
DOI: 10.1038/s41598-023-47644-1
Abstrakt: The use of regional citrate anticoagulation (RCA) in liver failure (LF) patients can lead to citrate accumulation. We aimed to evaluate serum levels of citrate and correlate them with liver function markers and with the Cat/Cai in patients under intensive care and undergoing continuous venovenous hemodiafiltration with regional citrate anticoagulation (CVVHDF-RCA). A prospective cohort study in an intensive care unit was conducted. We compared survival, clinical, laboratorial and dialysis data between patients with and without LF. Citrate was measured daily. We evaluated 200 patients, 62 (31%) with LF. Citrate was significantly higher in the LF group. Dialysis dose, filter lifespan, systemic ionized calcium and Cat/Cai were similar between groups. There were weak to moderate positive correlations between Citrate and indicators of liver function and Cat/Cai. The LF group had higher mortality (70.5% vs. 51.8%, p = 0.014). Citrate was an independent risk factor for death, OR 11.3 (95% CI 2.74-46.8). In conclusion, hypercitratemia was an independent risk factor for death in individuals undergoing CVVHDF-ARC. The increase in citrate was limited in the LF group, without clinical significance. The correlation between citrate and liver function indicators was weak to moderate.
(© 2023. The Author(s).)
Databáze: MEDLINE
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