Establishment of a citrate pharmacokinetics model and its application in RCA-CRRT
10.3760/cma.j.issn.1001-7097.2010.06.006
- VernacularTitle:连续性肾脏替代治疗时枸橼酸药物代谢动力学数学模型的构建
- Author:
Yin ZHENG
;
Zhongye XU
;
Zheng JIAO
;
Qiuyu ZHU
;
Junfeng LIU
;
Yong GU
;
Shanyan LIN
;
Chuanming HAO
;
Feng DING
- Publication Type:Journal Article
- Keywords:
Citrates;
Pharmacokinetics;
Continuous renal replacement therapy
- From:
Chinese Journal of Nephrology
2010;26(6):432-437
- CountryChina
- Language:Chinese
-
Abstract:
Objective To establish a citrate pharmacokinetics model which is applied to evaluate the risk of citrate accumulation in patients with liver dysfunction in the continuous renal replacement treatment (CRRT) with regional citrate anticoagulation (RCA). Methods The source of citrate for extracorporeal anticoagulation, the body clearance and filter elimination of citrate, which were the three major citrate fluxes of systemic citrate level, were combined into a single-pool, first order kinetic equation. The data from a published clinical study of systemic citrate kinetics in the intensive care unit patients with or without liver cirrhosis were adapted and the citrate kinetic equation was applied to predict the risk of systemic citrate accumulation in patients with normal, impaired and absent liver clearance while different RCA-CRRT protocols were carried out. Results The single pool, first order citrate kinetic modeling equation was as follows:Csys=C(0)·e-[(clb+clf)·t/V]+G/CLb+CLf×(1-e-[(clb+clf)·t/V])There was excellent agreement between published citrate measurements and our predictions. Kinetic modeling showed that the plasma citrate concentration of patients with normal citrate body clearance was no more than 1 mmol/L during common RCA-CRRT. The model predicted that when the single pass fractional extraction of citrate on the artificial kidney was above 66％, systemic steady citrate concentration would be among the safe range even in patients of impaired body metabolism of citrate.Conclusions The citrate kinetic model of RCA-CRRT can predict the risk of systemic citrate accumulation and provide the basis for designing the safe RCA-protocols for the patients with impaired body clearance of citrate.
