Blood and ultrafiltrate dosage of citrate as a useful and routine tool during continuous venovenous haemodiafiltration in septic shock patients
Blood and ultrafiltrate dosage of citrate as a useful and routine tool during continuous venovenous haemodiafiltration in septic shock patients
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DOI：
10.1093/ndt/gfr106
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发表时间：
2011-12-01
影响因子：
6.1
通讯作者：
Triolo, Giorgio
中科院分区：
文献类型：
--
作者：
Mariano, Filippo;Morselli, Maurizio;Triolo, Giorgio
背景。柠檬酸盐抗凝在危重症患者的肾脏替代治疗（RRT）中越来越受欢迎。为了研究柠檬酸盐是否在脓毒性休克患者体内蓄积，我们测定了连续静脉 - 静脉血液透析滤过（CVVHDF）期间血浆和透析液中的柠檬酸盐含量。
方法。使用一种商用试剂盒（柠檬酸裂解酶法）建立了柠檬酸盐的自动化常规测定方法。对12例接受CVVHDF及柠檬酸盐抗凝治疗的脓毒性休克患者，在体外研究了全身血液、回路血液以及超滤液中（在0、0.5、1、3、6、9、12、24、48和72小时）的柠檬酸盐水平。
结果。体外血液研究表明，对于柠檬酸盐仅在细胞外分布的情况，所测血浆柠檬酸盐浓度与预测浓度之间近乎呈单位相关性。治疗期间，全身动脉血柠檬酸盐中位数在治疗开始时（时间0）为0.09（0.06 - 0.12）mmol/L，治疗过程中为0.23（0.18 - 0.31）mmol/L；柠檬酸盐的筛分系数中位数为0.95（0.88 - 1.02），且不随CVVHDF流出液量（从1350到5100 mL/h）的不同而改变。通过滤器清除的柠檬酸盐和钙的净量与流出液量显著相关（分别为r = 0.85和0.78）。进入患者血流的柠檬酸盐负荷中位数为13.60（9.1 - 19.6，n = 68）mmol/h。尽管柠檬酸盐检测的成本分析表明每日成本略有增加（从2.96增加到3.51[原文如此]），但随着柠檬酸盐抗凝更广泛的应用，潜在的成本节约可能具有重要意义。
结论。在伴有肝功能障碍的脓毒性休克患者中，血柠檬酸盐水平对于指导RRT的临床应用是有用的，通过增加流出液量可有效调节超滤液中柠檬酸盐的丢失。
Background. Citrate anticoagulation is gaining popularity in renal replacement therapies (RRT) for critically ill patients. In order to study whether citrate accumulates in septic shock patients, we determined citrate in plasma and dialysate during continuous venovenous haemodiafiltration (CVVHDF).Methods. An automated routine determination of citrate was set up using a commercial kit (citrate lyase method). Twelve patients with septic shock on CVVHDF and citrate anticoagulation were studied ex vivo for citrate levels in systemic and circuit blood and in the ultrafiltrate (at 0, 0.5, 1, 3, 6, 9, 12, 24, 48 and 72 h).Results. In vitro blood studies showed a near unit correlation between the plasma measured and predicted citrate concentrations for an exclusive extracellular distribution of citrate. Median systemic arterial citratemias were 0.09 (0.06-0.12) mmol/L (Time 0) and 0.23 (0.18-0.31) mmol/L during treatment; median sieving coefficient for citrate was 0.95 (0.88-1.02) and did not change with different volumes of CVVHDF effluent (from 1350 to 5100 mL/h). Net citrate and calcium removal by filter significantly correlated with effluent volume (r = 0.85 and 0.78, respectively). Median citrate load entering in the patients' bloodstream was 13.60 (9.1-19.6, n = 68) mmol/h. Although cost analysis of the citrate test demonstrated a minimally increased daily cost (from 2.96 to 3.51(sic)), saving costs could be potentially relevant with more extended use of citrate anticoagulation.Conclusions. In septic shock patients with liver dysfunction citratemia is useful in guiding clinical application of RRT, where the citrate losses in the ultrafiltrate can be efficiently modulated by increasing the effluent volume.