Increased total to ionized calcium ratio during continuous venovenous hemodialysis with regional citrate anticoagulation
Increased total to ionized calcium ratio during continuous venovenous hemodialysis with regional citrate anticoagulation
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DOI：
10.1097/00003246-200104000-00010
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发表时间：
2001-04-01
影响因子：
8.8
通讯作者：
DuBose, T
中科院分区：
文献类型：
--
作者：
Meier-Kriesche, HU;Gitomer, J;DuBose, T
背景：柠檬酸盐抗凝通常用于持续静脉静脉血液透析（CVVHD），以减少出血并发症的风险。我们以前报道过一例肝衰竭患者接受柠檬酸盐为基础的CVVHD，血清总钙与电离钙的比值升高。肝脏柠檬酸代谢减少，导致全身柠檬酸升高被认为是原因。方法：为了确定柠檬酸盐为基础的CVVHD期间总钙与电离钙比值升高的发生率和临床意义，对161例接受柠檬酸盐为基础的CVVHD的患者进行了筛选，以确定总钙与电离钙比值升高的存在（总钙与电离钙比值升高的亚组组成研究组）。由于研究组患者均有肝功能衰竭，故将总钙与离子钙比值正常的患者分为无肝功能衰竭组（对照I）和肝功能衰竭组（对照II）。结果：12%的患者总钙离子比升高。33%的肝功能衰竭患者表现出总钙离子比升高。研究组的平均总钙水平显著高于对照组，平均电离钙水平显著低于对照组，平均总钙与电离钙的比值显著高于对照组。结果，研究组的平均氯化钙替代需要量明显高于对照组，钙与柠檬酸盐的平均输注比高于对照组，总钙与电离钙的比值升高与死亡率升高相关，没有患者出现电离性低钙血症或血清总钙升高的并发症。结论：在需要使用基于柠檬酸盐的局部抗凝治疗的CVVHD患者中，总钙与电离钙之比升高是系统性柠檬酸盐积累的证据，观察总钙与电离钙之比的变化有助于早期发现肝功能衰竭患者，这些患者不能适当地代谢柠檬酸盐，并且需要明显高于正常的氯化钙输注速率。
Background: Citrate anticoagulation is commonly used for continuous venovenous hemodialysis (CVVHD) to minimize the risk of bleeding complications. We have previously reported a liver failure patient undergoing citrate-based CVVHD with elevated serum total to ionized calcium ratio. Diminished liver metabolism of citrate with resultant elevated systemic citrate was thought to be the cause.Methods: To determine the incidence and clinical significance of an elevated total to ionized calcium ratio during citrate-based CVVHD, 161 patients undergoing citrate-based CVVHD were screened for the presence of an elevated total to ionized calcium ratio (the subset with increased total to ionized calcium ratio comprised the study group). Because all patients in the study group had liver failure, two control groups of patients with normal total to ionized calcium ratios were formed Hose without liver failure (control I) and those with liver failure (control II).Results:An elevated total to ionized calcium ratio was detected in 12% of all patients. Thirty-three percent of liver failure patients demonstrated an elevated total to ionized calcium ratio. The study group demonstrated significantly higher mean total calcium levels, significantly lower mean ionized calcium levels, and significantly higher mean total to ionized calcium ratios than controls. As a result, the study group also had significantly increased mean calcium chloride replacement requirements in comparison with controls, The mean calcium to citrate infusion ratio was elevated in the study group in comparison with controls, An elevated total to ionized calcium ratio was associated with increased mortality in comparison with controls, No patients suffered complications from ionized hypocalcemia or elevated serum total calcium.Conclusions: Systemic citrate accumulation as evidenced by an elevated total to ionized calcium ratio occurs commonly in patients requiring CVVHD using citrate-based regional anticoagulation, Observing changes in the total to ionized calcium ratio can aid in early detection of patients with hepatic failure who are unable to appropriately metabolize citrate and will require calcium chloride infusion rates significantly above normal.