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Serial measurement of electrolyte and citrate concentrations in blood-primed continuous hemodialysis circuits during closed-circuit dialysis

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Abstract

Background

For continuous renal replacement therapy in small infants, due to the large extracorporeal volume involved, blood priming can be necessary to prevent hypotension and hemodilution. Because packed red blood cells (RBCs) have high levels of potassium and citrate, closed-circuit dialysis is often performed. We assessed the metrics of closed-circuit dialysis and serial citrate concentration changes.

Methods

We performed dialysis of closed circuits primed with expired human packed RBC solution and 5% albumin. Blood and dialysate flow rates were 70 and 33.3 mL/min, respectively. The extracorporeal volume was 70 mL. We measured pH, electrolytes, and citrate in the closed circuit every 3 min for 15 min. We also assessed the adequacy of closed-circuit dialysis using the formula: [dialysate flow rate (mL/min) × time of dialysis (min)]/extracorporeal volume (mL) and we assessed the correlation between citrate and ionized calcium concentrations.

Results

To reach normal concentrations of sodium, potassium, and chloride, 2.4 times as much dialysate fluid as extracorporeal volume was needed. In contrast, for ionized calcium, bicarbonate, and citrate, 3.8 times as much dialysate fluid as extracorporeal volume was required. By simple linear regression analysis, the concentration of citrate was significantly correlated with that of ionized calcium.

Conclusions

For closed-circuit dialysis using an RBC solution, the formula [dialysate flow rate (mL/min) × time of dialysis (min)]/extracorporeal volume (mL) would be a better parameter to estimate efficacy, compared with other metrics. Additionally, the citrate concentration can be readily estimated from the ionized calcium concentration during closed-circuit dialysis.

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Acknowledgments

The hemofilters (EXCELFRO AEF-03; Asahi Kasei Medical Co., Ltd., Tokyo, Japan) were provided to D.S. by Asahi Kasei Medical Co., Ltd., Tokyo, Japan.

Funding

This work was supported by a Grant for Co-medical Staff Research to D.S. from the Japanese Society for Dialysis Therapy.

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Authors and Affiliations

  1. Department of Clinical Engineering, St. Luke’s International Hospital, Tokyo, Japan

    Daisuke Saito, Yoshihiro Inoue, Tomoyuki Hirayama, Itaru Ezaki & Hassu Kin

  2. Department of Nephrology, St. Luke’s International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan

    Takuya Fujimaru, Masaaki Nakayama & Yasuhiro Komatsu

  3. Faculty of Pharmaceutical Sciences, Hokuriku University, Kanazawa, Ishikawa, Japan

    Takuya Shuo

  4. Department of Healthcare Quality and Safety, Graduate School of Medicine, Gunma University, Maebashi, Gunma, Japan

    Yasuhiro Komatsu

Authors
  1. Daisuke Saito
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  2. Takuya Fujimaru
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  3. Yoshihiro Inoue
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  4. Tomoyuki Hirayama
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  5. Itaru Ezaki
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  6. Hassu Kin
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  7. Takuya Shuo
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  8. Masaaki Nakayama
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  9. Yasuhiro Komatsu
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Corresponding author

Correspondence to Takuya Fujimaru.

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Conflict of interest

The hemofilters (EXCELFRO AEF-03; Asahi Kasei Medical Co., Ltd., Tokyo, Japan) were provided to D.S. by Asahi Kasei Medical Co., Ltd., Tokyo, Japan. Other authors declare that they have no conflict of interest.

Ethical approval

The study protocol was approved by the Ethical Committee of St. Luke’s International Hospital.

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Saito, D., Fujimaru, T., Inoue, Y. et al. Serial measurement of electrolyte and citrate concentrations in blood-primed continuous hemodialysis circuits during closed-circuit dialysis. Pediatr Nephrol 35, 127–133 (2020). https://doi.org/10.1007/s00467-019-04318-3

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  • DOI: https://doi.org/10.1007/s00467-019-04318-3

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