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An observational study on the effects of nadroparin-based and citrate-based continuous venovenous hemofiltration on

Peter H J van der Voort1, Sonja R Postma, W Peter Kingma

  • 1Department of Intensive Care, Medical Centre Leeuwarden, Leeuwarden, The Netherlands. phjvdvoort@chello.nl

Blood Purification
|April 21, 2007
PubMed

Insights

Citrate continuous venovenous hemofiltration (CVVH) in critically-ill patients temporarily lowers serum ionized calcium (iCa) and negatively impacts calcium balance, increasing parathyroid hormone (PTH). Nadroparin showed no such effects.

Area of Science:

  • Nephrology
  • Intensive Care Medicine
  • Critical Care

Background:

  • Acute renal failure (ARF) management often requires continuous venovenous hemofiltration (CVVH).
  • Calcium homeostasis is crucial in critically-ill patients undergoing CVVH.
  • Anticoagulation strategies, such as citrate or nadroparin, may influence calcium balance.

Purpose of the Study:

  • To compare calcium homeostasis during citrate-based versus nadroparin-based CVVH in critically-ill patients with ARF.
  • To evaluate the impact of citrate CVVH on serum ionized calcium (iCa) and calcium balance.
  • To assess the effect on parathyroid hormone (PTH) levels.

Main Methods:

  • Observational study involving 11 patients on citrate CVVH, 9 on nadroparin CVVH, and 10 controls.
  • Citrate anticoagulation was selected for patients with bleeding risk.
  • Serum iCa, calcium balance, and PTH levels were monitored.

Main Results:

  • Citrate CVVH patients exhibited significantly lower serum iCa at 24 hours (0.87 mmol/l) compared to controls (1.1 mmol/l) and nadroparin (1.1 mmol/l).
  • Calcium balance was negative in the citrate group, unlike the nadroparin group.
  • Median serum PTH was significantly higher in the citrate group (30.0 pmol/l) versus controls (6.5 pmol/l).

Conclusions:

  • Citrate CVVH, with a target iCa of 0.8-0.9 mmol/l, leads to negative calcium balance and transient hypocalcemia.
  • This hypocalcemia in citrate CVVH patients results in an enhanced PTH response compared to nadroparin.
  • Careful monitoring of calcium levels and balance is essential during citrate CVVH.
Abstract

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