Citrate pharmacokinetics in critically ill liver failure patients receiving CRRT

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Research Article: Citrate pharmacokinetics in critically ill liver failure patients receiving CRRT
Author: Peerapat Thanapongsatorn, Weerachai Chaijamorn, Phatadon Sirivongrangson, Sasipha Tachaboon, Sadudee Peerapornratana, Nuttha Lumlertgul, Aroonrut Lucksiri & Nattachai Srisawat
Email: weerachai.cha@siam.edu
Department|Faculty: Faculty of Pharmacy,  Siam University, Bangkok 10160
Published Scientific Reports, Volume 12, Issue 1815, 2 February 2022, Pages 1-9

Citation

Thanapongsatorn P., Chaijamorn W., Sirivongrangson P., Tachaboon S., Peerapornratana S., Lumlertgul N., Lucksiri A., Srisawat N. (2022). Citrate pharmacokinetics in critically ill liver failure patients receiving CRRT. Scientific Reports, 12(1815), 1-9.


ABSTRACT

Citrate has been proposed as anticoagulation of choice in continuous renal replacement therapy (CRRT). However, little is known about the pharmacokinetics (PK) and metabolism of citrate in liver failure patients who require CRRT with regional citrate anticoagulation (RCA). This prospective clinical PK study was conducted at King Chulalongkorn Memorial Hospital between July 2019 to April 2021, evaluating seven acute liver failure (ALF) and seven acute-on-chronic liver failure (ACLF) patients who received CRRT support utilizing RCA as an anticoagulant at a citrate dose of 3 mmol/L. For evaluation of the citrate PK, we delivered citrate for 120 min and then stopped for a further 120 min. Total body clearance of citrate was 152.5 ± 50.9 and 195.6 ± 174.3 mL/min in ALF and ACLF, respectively. The ionized calcium, ionized magnesium, and pH slightly decreased after starting citrate infusion and gradually increased to baseline after stopping citrate infusion. Two of the ACLF patients displayed citrate toxicity during citrate infusion, while, no ALF patient had citrate toxicity. In summary, citrate clearance was significantly decreased in critically ill ALF and ACLF patients receiving CRRT. Citrate use as an anticoagulation in these patients is of concern for the risk of citrate toxicity.

Keywords: Citrate pharmacokinetics, Ultrasonography,Hypocalcemia, ALF, ACLF, CRRT.


Citrate pharmacokinetics in critically ill liver failure patients receiving CRRT

Faculty of Pharmacy, Siam University, Bangkok, Thailand

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