Document Detail

Citrate anticoagulation during post-dilution hemodiafiltration with a high cut-off (Theralite) membrane.
MedLine Citation:
PMID:  21624077     Owner:  NLM     Status:  MEDLINE    
Citrate anticoagulation has not yet been described for hemodiafiltration (HDF) with high cut-off (HCO) membranes, which can be used in the treatment of cast nephropathy secondary to multiple myeloma. A 57-year-old male patient with multiple myeloma and acute renal failure was treated with HDF using a HCO membrane (Theralite) each or every other day. Due to thrombocytopenia, citrate anticoagulation was done for the first 7 h, and anticoagulant-free HDF was performed for the last hour to avoid citrate accumulation. Magnesium, phosphate, and albumin were measured after 3, 6, and 8 h, and were replaced as necessary. Thirty-two post-dilution HDF procedures (8 h each, infusate 24 L) were performed with blood flow at 300-330 mL/h; sodium citrate 4% was infused at 300 mL/h and 1 mol/L calcium chloride was infused at a mean rate of 14.6 ± 1.1 mL/h. Calcium-free dialysate/infusate was used. Ionized calcium was stable (1.10 ± 0.06 before and 1.08 ± 0.06 mmol/L after HDF). Magnesium was stable (0.67 ± 0.12 before and 0.68 ± 0.05 mmol/L after HDF), with an average 390 ± 180 mg per procedure, substituted orally. There was no metabolic alkalosis or hypernatremia after the procedures, and no significant clotting was noted. The total/ionized calcium ratio (1.87 ± 0.22 before vs. 1.56 ± 0.20 after 6 h) and the corrected/ionized calcium ratio (2.02 ± 0.21 before vs. 1.88 ± 0.27 after 6 h) decreased during HDF, indicating no citrate accumulation. Citrate anticoagulation was effectively performed during 8 h of HCO membrane HDF. There were no side effects of citrate anticoagulation, nor were any signs of citrate accumulation noted.
Janko Kovač; Jakob Gubenšek; Andreja Marn Pernat; Jadranka Buturović-Ponikvar; Boštjan Kersnič; Jože Pretnar; Rafael Ponikvar
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Therapeutic apheresis and dialysis : official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy     Volume:  15     ISSN:  1744-9987     ISO Abbreviation:  Ther Apher Dial     Publication Date:  2011 Jun 
Date Detail:
Created Date:  2011-05-31     Completed Date:  2011-09-29     Revised Date:  2013-04-04    
Medline Journal Info:
Nlm Unique ID:  101181252     Medline TA:  Ther Apher Dial     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  283-6     Citation Subset:  IM    
Copyright Information:
© 2011 The Authors. Therapeutic Apheresis and Dialysis © 2011 International Society for Apheresis.
Department of Nephrology, University Medical Centre Ljubljana, Ljubljana, Slovenia.
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MeSH Terms
Acute Kidney Injury / etiology,  therapy
Anticoagulants / adverse effects,  therapeutic use*
Citrates / adverse effects,  therapeutic use*
Hemodiafiltration / methods*
Membranes, Artificial*
Middle Aged
Multiple Myeloma / complications
Thrombocytopenia / etiology
Reg. No./Substance:
0/Anticoagulants; 0/Citrates; 0/Membranes, Artificial; 1Q73Q2JULR/sodium citrate

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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