Regional citrate anticoagulation for continuous renal replacement therapy in the perioperative care of liver transplant recipients: a single center experience.

Abstract

Kidney injury with concomitant hemodialysis is a common finding in perioperative care of liver transplant patients. The aim of this study was to evaluate disturbances in acid-base status, electrolyte balance and citrate accumulation during hemodialysis with regional citrate anticoagulation in perioperative care of liver transplant recipients. A retrospective, single center evaluation was conducted of patients with severe liver dysfunction receiving renal replacement therapy in the perioperative care of liver transplantation in a multidisciplinary ICU of a university hospital. Within 5 days of ICU stay, 89 patients undergoing liver transplantation received regional citrate anticoagulation for hemodialysis. During the study period pH (7.39 [7.33/7.43] vs. 7.44 [7.39/7.47], P-value = 0.014), base excess values (-0.9 [-5.08/2.35] vs. 4.3 [1.93/8.21], P-value = 0.001) and standard bicarbonate (23.6 [20/26.9] vs. 28.2 [26.2/32.2], P-value = 0.001) significantly increased, whereas lactate levels (2.6 [1.60/4.45] vs. 1.25 [0.98/1.9], P-value = 0.071) and Catot /Caion -ratio decreased or remained below the upper reference. Hypocalcemia appeared mostly within 48 h after dialysis initiation. Although sodium levels increased during the observation, rates of hypernatremia were comparable between hemodialysis days 1 and 5. Hemodialysis using regional citrate anticoagulation remains a challenge in the perioperative care of liver transplant recipients. Major attention must be paid to acid-base disturbances and citrate accumulation within 48 h after dialysis initiation. Nevertheless, regional citrate anticoagulation in liver dysfunction is a feasible and valuable tool, when limitations and pitfalls are adequately considered.

• Authors: Christoph Sponholz, Utz Settmacher, Michael Bauer, Andreas Kortgen
• Journal: 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 (Ther Apher Dial) Vol. 19 Issue 1 Pg. 8-15 (Feb 2015) ISSN: 1744-9987 [Electronic] Australia
• PMID: 25196675 (Publication Type: Evaluation Study, Journal Article)
• Copyright: © 2014 The Authors. Therapeutic Apheresis and Dialysis © 2014 International Society for Apheresis.

Chemical References

• Anticoagulants
• Citric Acid

Topics

• Acid-Base Equilibrium
• Acute Kidney Injury (etiology, therapy)
• Anticoagulants (administration & dosage)
• Citric Acid (administration & dosage)
• Cohort Studies
• Female
• Graft Rejection
• Graft Survival
• Hospitals, University
• Humans
• Intensive Care Units
• Kidney Function Tests
• Liver Failure (diagnosis, surgery)
• Liver Transplantation (adverse effects, methods)
• Male
• Middle Aged
• Perioperative Care (methods)
• Prognosis
• Renal Dialysis (methods)
• Retrospective Studies
• Severity of Illness Index
• Statistics, Nonparametric
• Treatment Outcome