PMID- 36755836
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230210
IS  - 2048-8505 (Print)
IS  - 2048-8513 (Electronic)
IS  - 2048-8505 (Linking)
VI  - 16
IP  - 2
DP  - 2023 Feb
TI  - A prospective study on serum citrate levels and clinical correlations in patients 
      receiving regional citrate anticoagulation.
PG  - 285-292
LID - 10.1093/ckj/sfac223 [doi]
AB  - BACKGROUND: Current ways to diagnose citrate accumulation (CA) in patients 
      receiving regional citrate anticoagulation (RCA) continuous renal replacement 
      therapy (CRRT) are confounded by various clinical factors. Serum citrate 
      measurement emerges as a more direct way to diagnose CA, but its clinical utility 
      and optimal cut-off values remain undefined. This study examined serum citrate 
      kinetics and its diagnostic performance for CA in patients receiving RCA CRRT. 
      METHODS: A multicentre prospective study was carried out in two tertiary referral 
      centre intensive care units in Hong Kong with serum citrate levels measured at 
      baseline and 2, 6, 12, 24, 36, 48 and 72 h after initiation of RCA CRRT and their 
      relationships with the development of CA. RESULTS: Among the 133 patients 
      analysed, 18 patients (13.5%) developed CA. The serum citrate levels at baseline 
      and 2, 6 and 12 h after initiation of RCA CRRT in patients who had CA were 
      significantly higher than the non-CA group (P < .001 for all). The CA group also 
      had higher serum citrate levels than the non-CA group median 0.93 mmol/L 
      [interquartile range (IQR) 0.81-1.16) versus 0.37 mmol/L (IQR 0.26-0.57), 
      P < .001. Using a cut-off of 0.85 mmol/L, the serum citrate level had a 
      sensitivity of 0.77 and a specificity 0.96 for the diagnosis of CA [area under 
      the receiver operating characteristics curve (AUROC) 0.90, P < .001]. The 2-h and 
      6-h serum citrate levels had good discriminatory abilities for predicting 
      subsequent development of CA (AUROC 0.86 and 0.83 for 2-h and 6-h citrate levels 
      using cut-off values of 0.34 and 0.63 mmol/L, respectively; P < .001). 
      CONCLUSION: Serum citrate levels were significantly higher in patients with CA 
      compared with patients without CA. Serum citrate levels showed good performance 
      in diagnosing and predicting the development of CA.
CI  - (c) The Author(s) 2022. Published by Oxford University Press on behalf of the ERA.
FAU - To, Harmony H M
AU  - To HHM
AUID- ORCID: 0000-0001-9502-4440
AD  - Adult Intensive Care Unit, Queen Mary Hospital, Hong Kong.
FAU - Kwan, Arthur M C
AU  - Kwan AMC
AD  - Department of Anaesthesia and Intensive care, Tuen Mun Hospital, Hong Kong.
FAU - Leung, Natalie Y Y
AU  - Leung NYY
AD  - Adult Intensive Care Unit, Queen Mary Hospital, Hong Kong.
FAU - Chan, W M
AU  - Chan WM
AD  - Adult Intensive Care Unit, Queen Mary Hospital, Hong Kong.
FAU - Ngai, C W
AU  - Ngai CW
AUID- ORCID: 0000-0002-6852-3946
AD  - Adult Intensive Care Unit, Queen Mary Hospital, Hong Kong.
FAU - Wong, Alfred S K
AU  - Wong ASK
AUID- ORCID: 0000-0002-6785-7418
AD  - Adult Intensive Care Unit, Queen Mary Hospital, Hong Kong.
FAU - Tsai, Polly N W
AU  - Tsai PNW
AD  - Adult Intensive Care Unit, Queen Mary Hospital, Hong Kong.
FAU - Ma, Tammy S K
AU  - Ma TSK
AD  - Adult Intensive Care Unit, Queen Mary Hospital, Hong Kong.
FAU - Yam, Irene
AU  - Yam I
AD  - Division of Nephrology, Department of Medicine, University of Hong Kong, Hong 
      Kong.
FAU - Ng, Pauline Yeung
AU  - Ng PY
AUID- ORCID: 0000-0001-6671-5963
AD  - Division of Respiratory and Critical Care Medicine, Department of Medicine, 
      University of Hong Kong, Hong Kong.
FAU - Yap, Desmond Y H
AU  - Yap DYH
AUID- ORCID: 0000-0001-8179-8293
AD  - Division of Nephrology, Department of Medicine, University of Hong Kong, Hong 
      Kong.
LA  - eng
PT  - Journal Article
DEP - 20221015
PL  - England
TA  - Clin Kidney J
JT  - Clinical kidney journal
JID - 101579321
PMC - PMC9900571
OTO - NOTNLM
OT  - citrate accumulation
OT  - citrate toxicity
OT  - regional citrate anticoagulation
OT  - serum citrate level
EDAT- 2023/02/10 06:00
MHDA- 2023/02/10 06:01
PMCR- 2022/10/15
CRDT- 2023/02/09 02:18
PHST- 2022/06/06 00:00 [received]
PHST- 2023/02/09 02:18 [entrez]
PHST- 2023/02/10 06:00 [pubmed]
PHST- 2023/02/10 06:01 [medline]
PHST- 2022/10/15 00:00 [pmc-release]
AID - sfac223 [pii]
AID - 10.1093/ckj/sfac223 [doi]
PST - epublish
SO  - Clin Kidney J. 2022 Oct 15;16(2):285-292. doi: 10.1093/ckj/sfac223. eCollection 
      2023 Feb.