文摘
Background
Systemic citrate accumulation is a complication of regional citrate anticoagulation (RCA) during continuous renal replacement therapy (CRRT). Our objective was to determine the incidence of clinical signs consistent with citrate accumulation in a large and representative cohort of intensive care unit patients undergoing RCA-CRRT.Methods
<p>Patients treated with RCA-CRRT during 2008-2010 were retrospectively analyzed. Decreased systemic ionized calcium (iCa), increased demand for calcium substitution, elevated total calcium to iCa ratio, and metabolic acidosis were evaluated as indicators for citrate accumulation.Results
<p>In the 3-year period, 1070 patients were treated with RCA-continuous venovenous hemodialysis. Metabolic signs of citrate accumulation occurred in 32 patients (2.99%, 64.5卤14.0 years, 65.6% male, Acute Physiology and Chronic Health Evaluation score 34.2卤9.7): systemic iCa decreased to 1.01卤0.10 mmol/L with a simultaneous increase of the calcium substitution rate to 129%卤26%, and the mean total calcium to iCa ratio increased to 2.51卤0.54. All 32 patients had therapy-resistant shock with severe lactic acidosis (pH 7.20卤0.11, lactate 136卤61 mg/dL), indicating severe intracellular hypoxia. None of the patients survived.Conclusions
<p>The incidence of disarrangements consistent with citrate accumulation in patients undergoing RCA-continuous venovenous hemodialysis was low, taking place exclusively in patients with severe lactic acidosis due to multiorgan failure. This suggests that the appearance of citrate accumulation is secondary to a severe failure of cellular respiration.
