Biocompatibility parameters with standard and increased dose of citrate in hemodialysis : a randomized trial

Orsag, Aleša (author), Božič, Mojca (author), Hudoklin, Samo (author), Simčič, Saša (author), Gubenšek, Jakob (author)

Background: The dose of citrate needed in regional citrate anticoagulation (RCA) to achieve optimal biocompatibility is unknown. We performed a randomized trial comparing two doses (ACTRN12613001340729). Methods: In 30 patients a single hemodialysis with either standard (2.7 mmol/L) or increased dose of citrate (4 mmol/L) was performed. C5a-desArg, myeloperoxidase (MPO), thrombin-antithrombin complex (TAT), and platelet factor 4 (PF4) were measured and the inner surface of the dialyzer fibers was evaluated with scanning electron microscopy (SEM). Results: A good separation of anticoagulation effect was achieved (post-filter ionized calcium 0.20 vs. 0.31 mmol/L, p < 0.05). There was no effect of citrate dose on any of the biocompatibility parameters; transient and parallel increase in PF4 after 30 min and parallel increase in TAT after 4 h were observed. There were no visually detected clotting problems within the circuit and no significant hypocalcemia in either group. SEM clotting score was excellent and comparable in both groups (p = 0.59). Conclusions: Given the excellent results in both groups, absence of between group differences and inability of the increased dose of citrate to completely blunt the small residual increase in PF4 and TAT, we conclude that the standard dose of citrate seems sufficient in RCA for chronic hemodialysis.

• Language: English
• Keywords: biocompatibility, complement system, hemodialysis, myeloperoxidase, platelet factor 4, regional citrate anticoagulation, thrombin–antithrombin complex
• Work type: Article
• Typology: 1.01 - Original Scientific Article
• Organization: MF - Faculty of Medicine
• Publication status: Published
• Publication version: Version of Record
• Year: 2021
• Number of pages: 11 str.
• Numbering: Vol. 10, iss. 13, art. 2987
• PID: 20.500.12556/RUL-135718
• UDC: 616.1
• ISSN on article: 2077-0383
• DOI: 10.3390/jcm10132987
• COBISS.SI-ID: 69247491
• Publication date in RUL: 29.03.2022

Record is a part of a journal

• Title: Journal of clinical medicine
• Shortened title: J. clin. med.
• Publisher: MDPI
• ISSN: 2077-0383
• COBISS.SI-ID: 5405759

Licences

• License: CC BY 4.0, Creative Commons Attribution 4.0 International
• Link: http://creativecommons.org/licenses/by/4.0/
• Description: This is the standard Creative Commons license that gives others maximum freedom to do what they want with the work as long as they credit the author.
• Licensing start date: 04.07.2021

Secondary language

• Language: Slovenian
• Keywords: biokompatibilnost, hemodializa, mieloperoksidaza, antikoagulacija, trombin-antitrombin kompleks

Projects

• Funder: ARRS - Slovenian Research Agency
• Project number: P3-0323
• Name: Ledvične bolezni in nadomestna zdravljenja

• Funder: Other - Other funder or multiple funders
• Funding programme: University Medical Center Ljubljana
• Project number: 20180054