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Citrate Anticoagulation Control by Ionized Calcium Levels Does Not Prevent Hemostasis and Complement Activation During Hemodialysis
Author(s) -
Opatrný Karel,
Richtrová Pavlína,
Polanská Kamila,
Wirth Jan,
Šefrna František,
Brandl Martin,
Falkenhagen Dieter
Publication year - 2007
Publication title -
artificial organs
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 76
eISSN - 1525-1594
pISSN - 0160-564X
DOI - 10.1111/j.1525-1594.2007.00365.x
Subject(s) - thrombogenicity , hemostasis , platelet , von willebrand factor , complement system , hemodialysis , platelet activation , medicine , extracorporeal circulation , tissue factor , thrombin , chemistry , coagulation , immunology , antibody
The purpose of this study was to determine whether or not regional citrate anticoagulation (RCA) controlled by ionized calcium (iCa 2+ ) would overcome thrombogenicity, prevent hemostasis, and complement activation during hemodialysis (HD). RCA was performed in 10 patients during 10 HD sessions using a polysulfone membrane in an effort to keep iCa 2+ at dialyzer outlet at ≤0.4 mmol/L. Compared to baseline, plasma levels of thrombin‐antithrombin III complexes rose significantly at 240 min, and tissue factor and complement C5a component levels at 30 and 240 min of the procedure. Thrombocyte count declined significantly at 30 and 240 min, while activated clotting time (ACT) did not increase significantly, and platelet factor 4 as well as von Willebrand factor levels did not alter significantly. While ACT correlated significantly with some thrombogenicity markers, iCa 2+ did not correlate with ACT, changes in hemostasis, or C5a. We conclude the usually recommended iCa 2+ levels in the HD extracorporeal circuit did not guarantee the complete overcoming of thrombogenicity, prevention of hemostasis, and complement activation.