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Management of regional citrate anticoagulation for continuous renal replacement therapy:guideline recommendations from Chinese emergency medical doctor consensus

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Military Medical Research 2023年第6期10卷 733-750页

作者： Shu-Yuan Liu Sheng-Yong Xu Lu Yin Ting Yang Kui Jin Qiu-Bin Zhang Feng Sun Ding-Yu Tan Tian-Yu Xin Yu-Guo Chen Xiao-Dong Zhao Xue-Zhong Yu Jun Xu Emergency Medical Doctor Branch of the Chinese Medical Doctor Association Emergency Department The Sixth Medical CenterChinese PLA General HospitalBeijing 100048China State Key Laboratory of Complex Severe and Rare Diseases Emergency DepartmentPeking Union Medical College HospitalChinese Academy of Medical Science and Peking Union Medical CollegeBeijing 100730China Emergency Department Peking University Shenzhen HospitalShenzhen 518000China Emergency Department The First Affiliated Hospital of Kunming Medical UniversityKunming 650000China Emergency Department The First Affiliated Hospital of University of Science and Technology of ChinaHefei 230001China Emergency Department The Second Affiliated Hospital of Hainan Medical CollegeHaikou 570100China Emergency Department The First Affiliated Hospital of Nanjing Medical UniversityNanjing 210029China Emergency Depart‑ment Northern Jiangsu People’s HospitalClinical Medical College of Yang‑zhou UniversityYangzhou 225001China Emergency Department and Chest Pain Center Qilu Hospital of Shandong UniversityJinan 100005China Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine Jinan 100005China Key Laboratory of Emergency and Critical Care Medicine of Shandong Province Qilu Hospital of Shandong UniversityJinan 100005China Emergency Department The Fourth Medical CenterChinese PLA General HospitalBeijing 100048China Jiangxi Provincial People’s Hospital Nanchang330046China The Second Affiliated Hospital of Shenzhen University ShenzhenGuangdong 518035China The First Hos‑pital of Tsinghua University Beijing100016China The Affiliated Hospital and Medical School of Nantong University NantongJiangsu 226001China The First People’s Hospital of Lianyungang LianyungangJiangsu 222000China Shaanxi People’s Hospital Xi’an 710068China Renmin Hospital of Wuhan University Wuhan 430060China Shenzhen Hospital of South‑ern Medical University ShenzhenGuangdong 518000China The Second People’s Hospital of Huai’an Huai’anJiangsu 223002China The Affiliated Suqian Hospital of Xuzhou Medical Univers

Continuous renal replacement therapy(CRRT)is widely used for treating critically-ill patients in the emergency department in China.Anticoagulant therapy is needed to prevent clotting in the extracorporeal circulation during CRRT.Regional citrate anticoagulation(RCA)has been shown to potentially be safer and more effective,and is now recommended as the preferred anticoagulant method for CRRT.However,there is still a lack of unified standards for RCA management in the world,and there are many problems in using this method in clinical practice.The Emergency Medical Doctor Branch of the Chinese Medical Doctor Association(CMDA)organized a panel of domestic emergency medicine experts and international experts of CRRT to discuss RCA-related issues,including the advantages and disadvantages of RCA in CRRT anticoagulation,the principle of RCA,parameter settings for RCA,monitoring of RCA(mainly metabolic acid-base disorders),and special issues during RCA.Based on the latest available research evidence as well as the paneled experts'clinical experience,considering the generalizability,suitability,and potential resource utilization,while also balancing clinical advantages and disadvantages,a total of 16 guideline recommendations were formed from the experts'consensus.

关键词： Continuous renal replacement therapy Emergency Anticoagulation citrate Guideline Expert consensus

Improving sludge dewaterability via Fe^(2+) chelated citrate activated peroxydisulfate oxidation

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Journal of Environmental Sciences 2023年第3期125卷 223-233页

作者： Donghai Yuan Xinyu Li Siyu Xiong Jun Cui Jijiao Zhou Yingying Kou Key Laboratory of Urban Stormwater System and Water Environment Ministry of EducationBeijing University of Civil Engineering and ArchitectureBeijing 100044China Department of Environmental Science and Engineering Beijing University of Chemical TechnologyBeijing 100029China Huzhou Environmental Sanitation Management Center Huzhou 313000China

citrate (Ct) was chosen as a typical chelator used in the Fe^(2+)-peroxydisulfate (PDS) process to improve sludge dewaterability.The PDS-Fe^(2+)-Ct process exhibited better performance in sludge dewatering than PDS-Fe^(2+).Specifically,with a PDS dosage of 1.2 mmol/g VS,the molar ratio of PDS/Fe^(2+)and Ct/Fe^(2+)were 4:5 and 1:4,respectively,the capillary suction time decreased from 155.8 to 24.8sec,and the sludge cake water content decreased from 82.62%to 64.11%(-0.06MPa).The oxidation led to a reduced negative charge and a decrease in particle size.The enhanced sludge dewaterability and changes of sludge properties were attributed to the decomposition of extracellular polymeric substances,and it was explored by protein,polysaccharide,3D-EEMs,and FT-IR.Additionally,the quenching experiments of radical species demonstrated that SO_(4)-·played a more important role than·OH,and its productivity was improved with the addition of Ct.Moreover,the reasons for the improved productivity of radicals with the addition of Ct were discussed.The results of this study could serve as a basis for improving sludge dewatering using the PDS-Fe^(2+)-Ct process and suggest that the addition of Ct may improve the productivity of SO_(4)-·in the activation o PDS via Fe^(2+).

关键词： Wastewater sludge Dewaterability Peroxydisulfate oxidation citrate

citrate versus unfractionated heparin for anticoagulation in continuous renal replacement therapy

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Chinese Medical Journal 2013年第7期126卷 1344-1349页

作者： LIAO Yu-jie ZHANG Ling ZENG Xiao-xi FU Ping Division of Nephrology West China Hospital of Sichuan University Chengdu Sichuan 610041 China

Background Unfractionated heparin is the most commonly used anticoagulant in continuous renal replacement therapy （CRRT）, but it can increase the risk of bleeding. citrate is a promising substitute. Our study was to assess the efficacy and safety of citrate versus unfractionated heparin in CRRT. Methods We searched the MEDLINE, the EMBASE, the Cochrane Central Register of Controlled Trials, and the China National Knowledge Infrastructure Database until up to November 2011 for randomized controlled trials comparing citrate with unfractionated heparin in adult patients with acute kidney injury prescribed CRRT. The primary outcome was mortality and the secondary outcomes included circuit survival, control of uremia, risk of bleeding, transfusion rates, acid-base statuses, and disturbance of sodium and calcium homeostasis. Results Four trials met the inclusion criteria. Meta-analysis found no significant difference between two anticoagulants on mortality. Less bleeding and more hypocalcemic episodes were with citrate. citrate was superior or comparable to unfractionated heparin in circuit life. Conclusions citrate anticoagulation in CRRT seems to be superior in reducing bleeding risk and with a longer or similar circuit life, although there is more metabolic derangement. Mortality superiority has not been approved.

关键词： continuous renal replacement therapy anticoagulation citrate unfractionated heparin meta-analysis

Competitive and cooperative adsorption of arsenate and citrate on goethite

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Journal of Environmental Sciences 2009年第1期21卷 106-112页

作者： SHI Rong,JIA Yongfeng,WANG Chengzhi Institute of Applied Ecology,Chinese Academy of Sciences,Shenyang 110016,China Institute of Applied Ecology Chinese Academy of Sciences Shenyang 110016 China

The fate of arsenic in natural environments is influenced by adsorption onto metal （hydr）oxides. The extent of arsenic adsorption is strongly affected by coexisting dissolved natural organic acids. Recently, some studies reported that there existed competitive adsorption between arsenate and citrate on goethite. Humic acid is known to interact strongly with arsenate by forming complexes in aqueous solution, hence it is necessary to undertake a comprehensive study of the adsorption of arsenate/citrate onto goethite in the presence of one another. The results showed that at the arsenate concentrations used in this study （0.006-0.27 mmol/L）, citrate decreased arsenate adsorption at acidic pH but no effect was observed at alkaline pH. In comparison, citrate adsorption was inhibited at acidic pH, but enhanced at alkaline pH by arsenate. This was probably due to the formation of complex between arsenate and citrate like the case of arsenate with humic acid. These results implied that the mechanism of the adsorption of arsenate and citrate onto goethite in the presence of one another involved not only competition for binding sites, but the cooperation between the two species at the watergoethite interface as well.

关键词： adsorption arsenate citrate goethite

Removal of citrate and hypophosphite binary components using Fenton,photo-Fenton and electro-Fenton processes

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Journal of Environmental Sciences 2009年第1期21卷 35-40页

作者： Yao-Hui Huang Hsiao-Ting Su Li-Way Lin Department of Chemical Engineering "National" Cheng Kung University Tainan 701 Taiwan China. Sustainable Environment Research Center Tainan 701 Taiwan China

Both citrate and hypophosphite in aqueous solution were degraded by advanced oxidation processes （Fe^2＋/H2O2, UV/Fe^2＋/H2O2, and electrolysis/Fe^2＋/H2O2） in this study. Comparison of these techniques in oxidation efficiency was undertaken. It was found that Fenton process could not completely degrade citrate in the presence of hypophosphite since it caused a series inhibition. Therefore, UV light （photo-Fenton） or electron current （electro-Fenton） was applied to improve the degradation efficiency of the Fenton process. Results showed that both photo-Fenton and electro-Fenton processes could overcome the inhibition of hypophosphite, especially the electro-Fenton.

关键词： citrate hypophosphite wastewater advanced oxidation processes Fenton photo-Fenton electro-Fenton

Polymeric architectures of bismuth citrate based on dimeric building blocks

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Science China Chemistry 2010年第10期53卷 2152-2158页

作者： YANG Nan AN Yan CAI JiWen HU LiHong ZENG YiBo MAO ZongWan CHEN GuanHua SUN HongZhe Department of Chemistry The University of Hong KongHong KongChina School of Chemistry and Chemical Engineering Sun Yat-Sen UniversityGuangzhou 510275China Institute of Marine Materials Science and Engineering Shanghai Maritime UniversityShanghai 201306China School of Pharmaceutical Sciences Sun Yat-Sen UniversityGuangzhou 510080China

Four bismuth complexes, (H2En)[Bi2(cit)2(H2O)4/3]·(H2O)x (1), (H2En)3[Bi2(cit)2Cl4]·(H2O)x (2), (HPy)2[Bi2(cit)2(H2O)8/5]·(H2O)x (3) and (H2En)[Bi2(cit)2](H2O)x (4) [cit = citrate4-; En = ethylenediamine; Py = pyridine] have been synthesized and crystallized. The crystal structures reveal that the basic building blocks in all of these complexes are bismuth citrate dimeric units which combine to form polymeric architectures. The embedded protonated ethylenediamine and pyridine moieties in the polymeric frameworks have been identified by X-ray crystallography and solid-state cross polarization/magic angle spinning (CP/MAS) 13C NMR. Based on the framework of complex 1, a structural model of a clinically used antiulcer drug, ranitidine bismuth citrate (RBC) was generated. The behavior of the protonated amine-bismuth citrate complexes in acidic aqueous solution has been studied by electrospray ionization-mass spectrometry (ESI-MS).

关键词： bismuth citrate polymeric architecture crystal structure solid-state NMR ESI-MS

In vitro cytocompatibility evaluation of poly(octamethylene citrate) monomers toward their use in orthopedic regenerative engineering

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Bioactive Materials 2018年第1期3卷 19-27页

作者： Chuying Ma Ethan Gerhard Qiaoling Lin Silun Xia April Dawn Armstrong Jian Yang Department of Biomedical Engineering Materials Research InstituteThe Huck Institutes of the Life SciencesThe Pennsylvania State UniversityUniversity ParkPA 16802USA CATS College CanterburyKent CT13LQUK Department of Orthopaedics and Rehabilitation College of MedicineThe Pennsylvania State UniversityHersheyPA 17033USA

citrate based polymer poly(octamethylene citrate)(POC)has shown promise when formulated into composite material containing up to 65 wt%hydroxylapatite(HA)for orthopedic applications.Despite significant research into POC,insufficient information about the biocompatibility of the monomers 1,8-Octanediol and citrate used in its synthesis is available.Herein,we investigated the acute cytotoxicity,immune response,and long-term functionality of both monomers.Our results showed a cell-type dependent cytotoxicity of the two monomers:1,8-Octanediol induced less acute toxicity to 3T3 fibroblasts than citrate while presenting comparable cytotoxicity to MG63 osteoblast-like cells;however,citrate demonstrated enhanced compatibility with hMSCs compared to 1,8-Octanediol.The critical cytotoxic concentration values EC30 and EC50,standard for comparing cytotoxicity of chemicals,were also provided.Additionally,citrate showed slower and less inhibitory effects on long-term hMSC cell proliferation compared with 1,8-Octanediol.Furthermore,osteogenic differentiation of hMSCs exposure to citrate resulted in less inhibitory effect on alkaline phosphatase(ALP)production.Neither monomer triggered undesired pro-inflammatory responses.In combination with diffusion model analysis of monomer release from cylindrical implants,based on which the maximum concentration of monomers in contact with bone tissue was estimated to be 2.2104 mmol/L,far lower than the critical cytotoxic concentrations as well as the 1,8-Octanediol concentration(0.4 mg/mL or 2.7 mmol/L)affecting hMSCs differentiation,we provide strong evidence for the cytocompatibility of the two monomers degraded from citrate-based composites in the orthopedic setting.

关键词： Biodegradable Poly(octamethylene citrate) citrate 1,8-Octanediol Cytocompatibility Osteogenic differentiation Surface erosion

Determinants of Calcium Infusion Rate During Continuous Veno-venous Hemofiltration with Regional citrate Anticoagulation in Critically III Patients with Acute Kidney Injury

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Chinese Medical Journal 2016年第14期129卷 1682-1687页

作者： De-Lin Liu Li-Feng Huang Wen-Liang Ma Qi Ding Yue Han Yue Zheng Wen-Xiong Li DePartment of Critical Care Medicine Beiiing Luhe Hospital Capital Medical University Beijing 101149 China Department of Surgical Intensive Care Unit Beijing Chaoyang Hospital Capital Medical University Beijing 100020 China

Background： It is unclear that how to decide the calcium infusion rate during continuous veno-venous hemofiltration （CVVH） with regional citrate anticoagulation （RCA）. This study aimed to assess the determinants of calcium infusion rate during CVVH with RCA in critically ill patients with acute kidney injury （AKI）. Methods： A total of 18 patients with AKI requiring CVVH were prospectively analyzed. Postdilution CVVH was performed with a fixed blood flow rate of 150 ml/min and a replacement fluid flow rate of 2000 ml/h for each new circuit. The infusion of 4% trisodium citrate was started at a rate of 29.9 mmol/h prefilter and adjusted according to postfilter ionized calcium. The infusion of 10% calcium gluconate was initiated at a rate of 5.5 mmol/h and adjusted according to systemic ionized calcium. The infusion rate of trisodium citrate and calcium gluconate as well as ultrafiltrate flow rate were recorded at 1, 2, 4, 6, 12, and 24 h after starting CVVH respectively. The calcium loss rate by CVVH was also calculated. Results： Fifty-seven sessions of CVVH were performed in 18 AKI patients. The citrate infusion rate, calcium loss rate by CVVH, and calcium infusion rate were 31.30 （interquartile range： 2.70）, 4.60 ± 0.48, and 5.50 ± 0.35 retool/h, respectively. The calcium infusion rate was significantly higher than that of calcium loss rate by CVVH （P 〈 0.01）. The correlation coefficient between the calcium and citrate infusion rates, and calcium infusion and calcium loss rates by CVVH was -0.031 （P 〉 0.05） and 0.932 （P 〈 0.01）, respectively. In addition, calcium infusion rate （mmol/h） = 1.77 ± 0.8 x （calcium loss rate by CVVH, mmol/h）. Conclusions： The calcium infusion rate correlates significantly with the calcium loss rate by CVVH but not with the citrate infusion rate in a fixed blood flow rate during CVVH with RCA.

关键词： Anticoagulation Calcium citrate Hemofiltration

Alleviation by abscisic acid of Al toxicity in rice bean is not associated with citrate efflux but depends on ABI5-mediated signal transduction pathways

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Journal of Integrative Plant Biology 2019年第2期61卷 140-154页

作者： Wei Fan Jia Meng Xu Pei Wu Zhi Xin Yang He Qiang Lou Wei Wei Chen Jian Fen Jin Shao Jian Zheng Jian Li Yang College of Resources and Environment Yunan Agricultural University State Key Laboratory of Plant Physiology and Biochemistry College of Life Sciences Zhejiang University Institute of Life Sciences College of Life and Environmental Sciences Hangzhou Normal University

Under conditions of aluminum(Al) toxicity,which severely inhibits root growth in acidic soils, plants rapidly alter their gene expression to optimize physiological fitness for survival. Abscisic acid(ABA) has been suggested as a mediator between Al stress and gene expression, but the underlying mechanisms remain largely unknown. Here,we investigated ABA-mediated Al-stress responses, using integrated physiological and molecular biology approaches.We demonstrate that Al stress caused ABA accumulation in the root apex of rice bean(Vigna umbellata [Thunb.] Ohwi &Ohashi), which positively regulated Al tolerance. However,this was not associated with known Al-tolerance mechanisms. Transcriptomic analysis revealed that nearly one-third of the responsive genes were shared between the Al-stress and ABA treatments. We further identified a transcription factor, ABI5, as being positively involved in Al tolerance. Arabidopsis abi5 mutants displayed increased sensitivity to Al, which was not related to the regulation of AtALMT1 and AtMATE expression. Functional categorization of ABI5-mediated genes revealed the importance of cell wall modification and osmoregulation in Al tolerance, a finding supported by osmotic stress treatment on Al tolerance. Our results suggest that ABA signal transduction pathways provide an additional layer of regulatory control over Al tolerance in plants.

关键词： Alleviation by abscisic acid of Al toxicity in rice bean is not associated with citrate efflux but depends on ABI5-mediated sign ABA Figure ABI