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Hypercitratemia is a mortality predictor among patients on continuous venovenous hemodiafiltration and regional citrate anticoagulation

2023; Nature Portfolio; Volume: 13; Issue: 1 Linguagem: Inglês

10.1038/s41598-023-47644-1

2045-2322

Thais Oliveira Claizoni dos Santos, Carlos Eduardo dos Santos Ferreira, Cristóvão Luís Pitangueira Mangueira, Adriano Luiz Ammirati, Patrícia Faria Scherer, Marisa Petrucelli Doher, Thais Nemoto Matsui, Bento Fortunato Cardoso dos Santos, Virgílio Gonçalves Pereira, Marcelo C. Batista, Júlio César Martins Monte, Oscar Fernando Pavão dos Santos, Marcelino de Souza Durão,

Pancreatitis Pathology and Treatment

The use of regional citrate anticoagulation (RCA) in liver failure (LF) patients can lead to citrate accumulation. We aimed to evaluate serum levels of citrate and correlate them with liver function markers and with the Cat/Cai in patients under intensive care and undergoing continuous venovenous hemodiafiltration with regional citrate anticoagulation (CVVHDF-RCA). A prospective cohort study in an intensive care unit was conducted. We compared survival, clinical, laboratorial and dialysis data between patients with and without LF. Citrate was measured daily. We evaluated 200 patients, 62 (31%) with LF. Citrate was significantly higher in the LF group. Dialysis dose, filter lifespan, systemic ionized calcium and Cat/Cai were similar between groups. There were weak to moderate positive correlations between Citrate and indicators of liver function and Cat/Cai. The LF group had higher mortality (70.5% vs. 51.8%, p = 0.014). Citrate was an independent risk factor for death, OR 11.3 (95% CI 2.74-46.8). In conclusion, hypercitratemia was an independent risk factor for death in individuals undergoing CVVHDF-ARC. The increase in citrate was limited in the LF group, without clinical significance. The correlation between citrate and liver function indicators was weak to moderate.