BACKGROUNDUnfractionated 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.

METHODSWe 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.

RESULTSFour 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.

CONCLUSIONSCitrate 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.

Anticoagulants ; therapeutic use ; Citric Acid ; therapeutic use ; Heparin ; therapeutic use ; Humans ; Randomized Controlled Trials as Topic ; Renal Replacement Therapy ; methods

OBJECTIVETo compare the effect of citric acid stimulation on salivary alpha-amylase (sAA), total protein (TP), salivary flow rate, and pH value between Pi deficiency (PD) children and healthy children, thereby providing evidence for Pi controlling saliva theory.

METHODSTwenty PD children were recruited, and 29 healthy children were also recruited at the same time. Saliva samples from all subjects were collected before and after citric acid stimulation. The sAA activity and amount, TP contents, salivary flow rate, and pH value were determined and compared.

RESULTS(1) Citric acid stimulation was able to significantly increase salivary flow rate, pH value, sAA activities, sAA specific activity and sAA amount (including glycosylated and non-glycosylated sAA amount) in healthy children (P<0.05), while it could markedly increase salivary flow rate, pH value, and glycosylated sAA levels in PD children (P<0.05); (2) Although there was no statistical difference in determined salivary indices between the two groups (P>0.05), salivary indices except salivary flow rate and glycosylated sAA levels decreased more in PD children. There was statistical difference in sAA activity ratio, sAA specific activity ratio, and the ratio of glycosylated sAA levels between PD children and healthy children (P<0.05).

CONCLUSIONPD children had decreased response to citric acid stimulation.

Child ; Citric Acid ; therapeutic use ; Humans ; Medicine, Chinese Traditional ; Saliva ; Salivary alpha-Amylases ; metabolism ; alpha-Amylases

Acute Kidney Injury/therapy* ; Anticoagulants/therapeutic use* ; Blood Coagulation ; Child ; Citrates ; Citric Acid/therapeutic use* ; Continuous Renal Replacement Therapy ; Humans ; Renal Replacement Therapy

BACKGROUNDIt 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).

METHODSA 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.

RESULTSFifty-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 mmol/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 × (calcium loss rate by CVVH, mmol/h).

CONCLUSIONSThe 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.

Acute Kidney Injury ; drug therapy ; therapy ; Adult ; Aged ; Anticoagulants ; therapeutic use ; Calcium ; administration & dosage ; therapeutic use ; Citric Acid ; therapeutic use ; Female ; Hemofiltration ; methods ; Humans ; Male ; Middle Aged ; Prospective Studies

Not only the evolution of the processing of Fructus Crataegi, but also the difference of chemical consitituents, pharmacological effects and clinical application before and after the processing are reviewed, based on 26 references of literature. A way to further study the processing of Fructus Crataegi is provided.
Antidiarrheals ; therapeutic use ; Citric Acid ; analysis ; Crataegus ; chemistry ; Diarrhea ; drug therapy ; Drugs, Chinese Herbal ; chemistry ; pharmacology ; therapeutic use ; Flavones ; analysis ; Fruit ; chemistry ; Hot Temperature ; Humans ; Phytotherapy ; Plants, Medicinal ; chemistry ; Technology, Pharmaceutical ; methods ; Trace Elements ; analysis

OBJECTIVETo observe the antitussive, expectorant and antiashmatic effects of the extract from Citrus grandist var. tomentosa.

METHODThe cough models induced by ammonia liquor in mice and citric acid in guines pigs were used to observe the antitussive effects. The methods of phenel red execretion in mice and phlegm displacement of rats were used to investigate the expectorant effects. Bronchial asthma model induced by histamine-acetylcholine in guinea pigs was used to observe the antiasthmatic effects.

RESULTThe extract from the title plant could inhibit the cough induced by ammonia in mice, decrease the frequency of cough induced by citric acid in guineas pig and prolong the latent period of cough. The extract also could obviously increase phenol red output of trachea in mice, promote expectoration in rats and prolong the latent period of asthma induced by histamine-acetylcholine in guinea pigs.

CONCLUSIONThe extract from C. grandis var. tomenfosa has significant antitussive, expectorant and antiasthmatic effects.

Acetylcholine ; Ammonia ; Animals ; Anti-Asthmatic Agents ; administration & dosage ; isolation & purification ; therapeutic use ; Antitussive Agents ; administration & dosage ; isolation & purification ; therapeutic use ; Asthma ; chemically induced ; drug therapy ; Citric Acid ; Citrus ; chemistry ; Cough ; chemically induced ; drug therapy ; Dose-Response Relationship, Drug ; Drugs, Chinese Herbal ; administration & dosage ; isolation & purification ; therapeutic use ; Expectorants ; administration & dosage ; isolation & purification ; therapeutic use ; Female ; Fruit ; chemistry ; Guinea Pigs ; Histamine ; Male ; Mice ; Phytotherapy ; Plants, Medicinal ; chemistry ; Rats ; Rats, Sprague-Dawley

To evaluate the safety and efficiency of citrate anticoagulant-based continuous blood purification in patients at high risk of bleeding. 
 Methods: One hundred and fifty-two patients at high risk of bleeding were divided into local citrate group (group A, n=68) and heparin group (group B, n=84). Clotting function, change of pH, ionized sodium, bicarbonate ion, ionized calcium, activated clotting time (ACT) and complications were monitored before and during treatment. 
 Results: Compared to the group A, the incidence of clotting in filter and chamber, the degree of bleeding or fresh bleeding were significantly reduced in the group B (P<0.05). ACT of post-filter at 4, 8 and 12 h during the treatment in the group A was significantly extended compared with that without treatment (P<0.05), while there was no significant change in group B (P>0.05). The pH value, the levels of ionized sodium, bicarbonate ion and ionized calcium during the treatment were maintained in normal range in both group A and group B.
 Conclusion: Local citrate-based continuous blood purification can achieve effective anticoagulation and decrease the incidence of bleeding. It is an ideal choice for patients at high risk of bleeding.
Anticoagulants ; pharmacology ; Bicarbonates ; blood ; Blood Coagulation ; drug effects ; Blood Coagulation Tests ; Calcium ; blood ; Citrates ; Citric Acid ; therapeutic use ; Female ; Hemodiafiltration ; adverse effects ; methods ; Hemofiltration ; Hemorrhage ; etiology ; prevention & control ; Heparin ; therapeutic use ; Humans ; Intensive Care Units ; Male ; Reference Values ; Renal Dialysis ; Sodium ; blood ; Treatment Outcome