scholarly journals Biocompatibility Parameters with Standard and Increased Dose of Citrate in Hemodialysis—A Randomized Trial

2021 ◽  
Vol 10 (13) ◽  
pp. 2987
Author(s):  
Alesa Orsag ◽  
Mojca Bozic-Mijovski ◽  
Samo Hudoklin ◽  
Sasa Simcic ◽  
Jakob Gubensek
Keyword(s):  
Randomized Trial ◽  
Standard Dose ◽  
Chronic Hemodialysis ◽  
Regional Citrate Anticoagulation ◽  
Group Differences ◽  
Good Separation ◽  
Platelet Factor ◽  
Parallel Increase ◽  
Inner Surface ◽  
Post Filter

Background: The dose of citrate needed in regional citrate anticoagulation (RCA) to achieve optimal biocompatibility is unknown. We performed a randomized trial comparing two doses (ACTRN12613001340729). Methods: In 30 patients a single hemodialysis with either standard (2.7 mmol/L) or increased dose of citrate (4 mmol/L) was performed. C5a-desArg, myeloperoxidase (MPO), thrombin-antithrombin complex (TAT), and platelet factor 4 (PF4) were measured and the inner surface of the dialyzer fibers was evaluated with scanning electron microscopy (SEM). Results: A good separation of anticoagulation effect was achieved (post-filter ionized calcium 0.20 vs. 0.31 mmol/L, p < 0.05). There was no effect of citrate dose on any of the biocompatibility parameters; transient and parallel increase in PF4 after 30 min and parallel increase in TAT after 4 h were observed. There were no visually detected clotting problems within the circuit and no significant hypocalcemia in either group. SEM clotting score was excellent and comparable in both groups (p = 0.59). Conclusions: Given the excellent results in both groups, absence of between group differences and inability of the increased dose of citrate to completely blunt the small residual increase in PF4 and TAT, we conclude that the standard dose of citrate seems sufficient in RCA for chronic hemodialysis.

scholarly journals P1069COMPARISON OF BIOCOMPATIBILITY OF REGULAR AND INCREASED DOSE OF CITRATE IN CHRONIC HEMODIALYSIS - PRELIMINARY RESULTS OF A RANDOMIZED TRIAL

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Alesa Orsag ◽  
Mojca Bozic-Mijovski ◽  
Sasa Simcic ◽  
Jakob Gubensek
Keyword(s):  
Standard Dose ◽  
Chronic Hemodialysis ◽  
Regional Citrate Anticoagulation ◽  
Arterial Line ◽  
Dialysis Dose ◽  
Platelet Factor ◽  
Hemodialysis Session ◽  
Significant Difference ◽  
Randomized Control ◽  
And Oxidative Stress

Abstract Background and Aims The dose of citrate that is needed in regional citrate anticoagulation (RCA) to achieve optimal biocompatibility of the extracorporeal circuit is not known. Insufficient biocompatibility is related with increased inflammation and oxidative stress and therefore higher risk for cardiovascular events, as well as decreased dialysis dose. Biocompatibility is multifaceted and includes activation of coagulation and complement cascades, as well as degranulation of leukocyte and platelets. We performed a randomized control trial (ACTRN12613001340729) to compare regular and increased dose of citrate in RCA. Method 30 chronic hemodialysis patients were randomly assigned to a single hemodialysis session with RCA using either regular (2.7 mmol/l) or increased dose of citrate (4.0 mmol/l). Markers of activation of complement system (C5a), activation of hemostasis (thrombin – antitrombin complex (TAT)), activation of platelets (platelet factor 4 (PF4)) and activation of leukocyte (myeloperoxidase (MPO)) were taken at the beginning (time 0), after 30 minutes (arterial line) and after 4 hours (arterial and venous line) of dialysis. Results were corrected for changes in hematocrit, and compared between groups using T test. Results There was no significant difference in any of the measured biocompatibility parameters between the two citrate dose groups at any of the time points. We have observed a significant, but transient increase in PF4 after 30 minutes (28 +/- 17 to 47 +/-29 IU/mL vs. 30 +/-17 to 54 +/- 33 IU/mL, p&lt;0.05 for both groups), which was parallel in both groups (p=0.76 for between group comparison). No significant changes in TAT, MPO or C5a were observed during dialysis. There were no clotting problems or significant hypocalcemia observed in either group. Conclusion Given the absence of significant increase in the majority of biocompatibility parameters at the standard dose of citrate and absence of blunting of PF4 increase by the higher dose of citrate, the standard dose of citrate (2.7 mmol/l) seems sufficient in RCA for chronic hemodialysis.

scholarly journals Discrepant post filter ionized calcium concentrations by common blood gas analyzers in CRRT using regional citrate anticoagulation

Critical Care ◽  
2015 ◽  
Vol 19 (1) ◽  
Author(s):  
Patrik Schwarzer ◽  
Sven-Olaf Kuhn ◽  
Sylvia Stracke ◽  
Matthias Gründling ◽  
Stephan Knigge ◽  
...  
Keyword(s):  
Ionized Calcium ◽  
Regional Citrate Anticoagulation ◽  
Blood Gas ◽  
Citrate Anticoagulation ◽  
Post Filter

Elevation Of Antithrombin III By Sulfinpyrazone Therapy In Chronic Renal Failure

1981 ◽  
Author(s):  
M Bern ◽  
J Green
Keyword(s):  
Renal Failure ◽  
Chronic Renal Failure ◽  
Antithrombin Iii ◽  
Chronic Hemodialysis ◽  
Protective Effects ◽  
Platelet Factor ◽  
At Iii ◽  
Before And After ◽  
Artery Disease ◽  
And Function

Sulfinpyrazone can reduce the incidence of thrombosis of A-V shunts in chronic renal failure. The drug is also reported to prevent acute deaths from coronary artery disease. This study was to determine mechanisms for these protective effects.Patients on chronic hemodialysis served as the study models. Six patients on dialysis three times per week for 6 or more months received sulfinpyrazone 200 mgm t.i.d. p.o. for 14 days. Blood samples were obtained before dialysis was begun before and after the 14 days of drug therapy.Results are shown as mean ± standard error of mean.AT III levels rose significantly by functional and immune assays. Functional levels (by von Kaulla technique) rose 24.5 ± 3.1 sec. to 47.3 + 5.5 sec. (P>.005) Plasma protein AT III (by radial immunodiffusion) rose 31.2 ± 2.17 mg/dl to 37.9 ± 2.1 mgm/dl. (P>.01) Platelet factor 4 (by Abbot radioimmunology assay) fell from 46.4 + 13.6 ngm/ml to 9.5 ± 1.1 ngm/ml.(P>.005) The concentration of thrombin-anti-thrombin complex (by R. Rosenberg, Harvard Medical School, Boston) rose from 4.2 ± .09 to 8.4 ± 1.0 (P>.005)Thus it appears that sulfinpyrazone elevates antithrombin concentration and function while simultaneously suppressing platelet release. These two effects may or may not be mutually dependent. The clinical efficacy of sulfinpyrazone may relate in part to the elevation of antithrombin III, probably by inhibiting its consumption, while also inhibiting platelet function.

scholarly journals A randomized trial of high- vs standard-dose mitoxantrone with cytarabine in elderly patients with acute myeloid leukemia

Leukemia ◽  
1997 ◽  
Vol 11 (4) ◽  
pp. 485-489 ◽  
Author(s):  
EJ Feldman ◽  
K Seiter ◽  
L Damon ◽  
C Linker ◽  
H Rugo ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Elderly Patients ◽  
Randomized Trial ◽  
Myeloid Leukemia ◽  
Standard Dose ◽  
Acute Myeloid

Imatinib 800 mg: Preliminary Results of a Phase II Trial of the GIMEMA CML Working Party in Intermediate Sokal Risk Patients and Status-of-the-Art of an Ongoing Multinational, Prospective Randomized Trial of Imatinib Standard Dose (400 mg Daily) vs High Dose (800 mg Daily) in High Sokal Risk Patients.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 1098-1098
Author(s):  
Gianantonio Rosti ◽  
Giovanni Martinelli ◽  
Fausto Castagnetti ◽  
Nicoletta Testoni ◽  
Giorgina Specchia ◽  
...  
Keyword(s):  
High Risk ◽  
Randomized Trial ◽  
Phase Ii ◽  
Response Rate ◽  
Phase Ii Trial ◽  
Standard Dose ◽  
Phase Iii ◽  
High Dose ◽  
Molecular Response ◽  
Risk Patients

Abstract The conventional treatment of chronic myeloid leukemia (CML) in early chronic phase (ECP) is imatinib 400 mg daily. The estimated rates of major (MCgR) and complete cytogenetic response (CCgR) at 42 months are 91% and 84%, respectively (IRIS Trial - F Guilhot, ASH 2004), with a survival free from accelerated and blastic phase of 84%. The rates of CCgR are significantly different according to Sokal score, being 91%, 84% and 69% for low, intermediate and high risk categories. Phase I and II trials of imatinib have clearly shown a dose-response effect; more importantly, a single center phase II trial of imatinib 800 mg in ECP showed significantly better results vs standard dose, in terms of CCgR (90% vs 74%) and of complete molecular response (28% vs 7% at 18 months) [H. Kantarjian et al, Blood 103 (8), 2004]. The GIMEMA (Gruppo Italiano Malattie Ematologiche dell’Adulto) CML WP is conducting a phase II trial of imatinib 800 mg in intermediate Sokal risk in ECP (trial CML/021). Overall, 89 pts (mean age 53 yrs) have been enrolled. Fourty-four patients completed 6 months of treatment: the complete hematological response rate is 100%; the MCgR and CCgR are 90% and 81%, respectively. The 6 months CCgR rate of this trial parallels the IRIS trial one in intermediate risk cases (84%), with a much shorter treatment period. The major molecular response rate at 6 months (RTQ-PCR as ratio BCR-ABL/ABL) is 56% (cut-off ≤ 0.12%) or 41% (cut-off ≤0.05%). The compliance to the treatment improved time by time, being 47% the patients receiving ≥ 80% of the scheduled dose between months 1–3 and 60% between months 4 - 6. A second project, exploring imatinib high dose, is reserved to high risk cases: a multinational working group, within the frame of Leukemianet CML WP, is conducting a phase III randomized trial (1:1) of imatinib 400 mg vs 800 mg in high Sokal risk in ECP. By July 31, 2005, 80 patients have been enrolled: GIMEMA CML WP (44 pts), Nordic Countries - Sweden, Denmark, Norway and Finland (25 pts), Turkey (10 pts) and Israel (1 pt).

Standard Chemotherapy Compared With High-Dose Chemoradiotherapy for Multiple Myeloma: Final Results of Phase III US Intergroup Trial S9321

2006 ◽  
Vol 24 (6) ◽  
pp. 929-936 ◽  
Author(s):  
Bart Barlogie ◽  
Robert A. Kyle ◽  
Kenneth C. Anderson ◽  
Philip R. Greipp ◽  
Hillard M. Lazarus ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Maintenance Therapy ◽  
Randomized Trial ◽  
Survival Time ◽  
Standard Dose ◽  
Response Rates ◽  
Prospective Randomized Trial ◽  
Phase Iii ◽  
High Dose ◽  
Tumor Reduction

Purpose Results of a prospective randomized trial conducted by the Intergroupe Francais du Myélome (IFM 90) indicated that autologous hematopoietic cell–supported high-dose therapy (HDT) effected higher complete response rates and extended progression-free survial (PFS) and overall survival (OS) compared with standard-dose therapies (SDT) for patients with multiple myeloma (MM). Patients and Methods In 1993, three North American cooperative groups launched a prospective randomized trial (S9321) comparing HDT (melphalan [MEL] 140 mg/m2 plus total-body irradiation 12 Gy) with SDT using the vincristine, carmustine, MEL, cyclophosphamide, and prednisone regimen. Responders on both arms (≥ 75%) were randomly assigned to interferon (IFN) or no maintenance treatment. Results With a median follow-up time of 76 months, no differences were observed in response rates between the two study arms (HDT, n = 261 patients; SDT, n = 255 patients). Similarly, PFS and OS durations did not differ between the HDT and SDT arms, with 7-year estimates of PFS of 17% and 16%, respectively, and OS of 37% and 42%, respectively. Of 242 patients achieving at least 75% tumor reduction, no difference was observed in PFS or OS among the 121 patients randomly assigned to IFN and the 121 patients randomly assigned to no maintenance therapy. Among 157 patients relapsing on SDT, 87 received a salvage autotransplantation; their median survival time of 30 months was only slightly better than the survival time of the remaining patients who were managed with further SDT (23 months; P = .13). Conclusion The HDT and SDT regimens used in S9321 yielded comparable response rates and PFS and OS durations. IFN maintenance therapy did not benefit patients who achieved ≥ 75% tumor reduction on either arm.

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