Читать книгу Current Perspectives in Kidney Diseases - Группа авторов - Страница 34

Measurement of citrate concentration in the blood is not available in the daily routine, so the most commonly accepted clinical markers for citrate accumulation [8] are as follows:

• An increased ratio of total calcium (tCa) to iCa (tCa/iCa),

• Metabolic acidosis with or without an increased anion gap, and

• Elevated demand for calcium substitution.

A calcium ratio (tCa/iCa) of 2.5 is often indicated as the critical threshold for enhanced risk of metabolic complications due to impaired citrate metabolism. Nevertheless, it has been reported that a lower cutoff of 2.1 appears to accurately predict the citrate accumulation (systemic citrate concentration 1 mmol/L) with high sensitivity and specificity (89 and 100%, respectively) [28].

However, the incidence of metabolic disarrangements resulting from citrate accumulation has been found to be rather low since it generally affects less than 3% of all CRRT patients on RCA, and clinical diagnosis of citrate accumulation is found exclusively in severely ill patients with multiorgan failure and severe lactic acidosis [24].