Maintaining normal levels of ionized calcium during citrate-based renal replacement therapy is associated with stable parathyroid hormone levels
Maintaining normal levels of ionized calcium during citrate-based renal replacement therapy is associated with stable parathyroid hormone levels
Background/Aims: Citrate is an effective anticoagulant during continuous renal replacement therapy (CRRT). Previous studies showed raised parathyroid hormone (PTH) levels when aiming for serum ionized calcium [Cai] between 0.8 and 1.1 mmol/l. Our objective was to assess whether citrate-based CRRT with physiologic target systemic [Cai] between 1.12 and 1.20 mmol/l could maintain stable PTH levels.
Methods: Measurement of intact PTH (PTHi) in 30 consecutive critically ill patients treated with citrate-based CRRT.
Results: Thirty patients [mean age: 70.4 (SD 11.3) years; 56.7% males] were enrolled. Mean serum [Cai] was 1.16 mmol/l (SD 0.09), 1.13 mmol/l (SD 0.09), 1.17 mmol/l (SD 0.05) and 1.16 mmol/l (SD 0.04) at baseline, 12, 24 and 48 h, respectively (p = 0.29). Median PTHi levels (interquartile range) at baseline, 12, 24 and 48 h were 66.5 (43-111), 109 (59.5-151.5), 88.5 (47-133) and 85 pg/ml (53-140), respectively. The differences between baseline and 12 h and across all time points were statistically not significant (p = 0.16 and p = 0.49, respectively). In a mixed-effects model, each 0.1 mmol/l increase in serum [Cai] was associated with a 31.2% decrease in PTHi (p < 0.001). Results were unchanged after adjustment for age, gender, magnesium, phosphate, arterial pH and time spent on CRRT.
Conclusions: Maintaining systemic [Cai] within the physiologic range was associated with stable PTHi levels.
124-131
Raimundo, M.
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Crichton, S.
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Lei, K.
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Sanderson, B.
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Smith, J.
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Brooks, J.
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Ng, J.
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Lemmich Smith, J.
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McKenzie, C.
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Beale, R.
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Dickie, H.
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Ostermann, M.
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Raimundo, M.
382e8d07-f026-4b96-9ce0-b904ac814658
Crichton, S.
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Lei, K.
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Sanderson, B.
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Smith, J.
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Brooks, J.
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Ng, J.
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Lemmich Smith, J.
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McKenzie, C.
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Beale, R.
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Dickie, H.
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Ostermann, M.
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Raimundo, M., Crichton, S., Lei, K., Sanderson, B., Smith, J., Brooks, J., Ng, J., Lemmich Smith, J., McKenzie, C., Beale, R., Dickie, H. and Ostermann, M.
(2013)
Maintaining normal levels of ionized calcium during citrate-based renal replacement therapy is associated with stable parathyroid hormone levels.
Nephron - Clinical Practice, 124 (1-2), .
(doi:10.1159/000355860).
Abstract
Background/Aims: Citrate is an effective anticoagulant during continuous renal replacement therapy (CRRT). Previous studies showed raised parathyroid hormone (PTH) levels when aiming for serum ionized calcium [Cai] between 0.8 and 1.1 mmol/l. Our objective was to assess whether citrate-based CRRT with physiologic target systemic [Cai] between 1.12 and 1.20 mmol/l could maintain stable PTH levels.
Methods: Measurement of intact PTH (PTHi) in 30 consecutive critically ill patients treated with citrate-based CRRT.
Results: Thirty patients [mean age: 70.4 (SD 11.3) years; 56.7% males] were enrolled. Mean serum [Cai] was 1.16 mmol/l (SD 0.09), 1.13 mmol/l (SD 0.09), 1.17 mmol/l (SD 0.05) and 1.16 mmol/l (SD 0.04) at baseline, 12, 24 and 48 h, respectively (p = 0.29). Median PTHi levels (interquartile range) at baseline, 12, 24 and 48 h were 66.5 (43-111), 109 (59.5-151.5), 88.5 (47-133) and 85 pg/ml (53-140), respectively. The differences between baseline and 12 h and across all time points were statistically not significant (p = 0.16 and p = 0.49, respectively). In a mixed-effects model, each 0.1 mmol/l increase in serum [Cai] was associated with a 31.2% decrease in PTHi (p < 0.001). Results were unchanged after adjustment for age, gender, magnesium, phosphate, arterial pH and time spent on CRRT.
Conclusions: Maintaining systemic [Cai] within the physiologic range was associated with stable PTHi levels.
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Accepted/In Press date: 17 September 2013
e-pub ahead of print date: 2 November 2013
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Local EPrints ID: 480078
URI: http://eprints.soton.ac.uk/id/eprint/480078
PURE UUID: 47c40f8f-0891-4eb7-a390-186bb665f448
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Date deposited: 01 Aug 2023 16:45
Last modified: 17 Mar 2024 04:23
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Author:
M. Raimundo
Author:
S. Crichton
Author:
K. Lei
Author:
B. Sanderson
Author:
J. Smith
Author:
J. Brooks
Author:
J. Ng
Author:
J. Lemmich Smith
Author:
C. McKenzie
Author:
R. Beale
Author:
H. Dickie
Author:
M. Ostermann
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