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Anesth Analg 2004;99:1199-1204
© 2004 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000132780.87036.F5

CRITICAL CARE AND TRAUMA

Parathyroid Hormone Secretion During Citrate Anticoagulated Hemodialysis in Acutely Ill Maintenance Hemodialysis Patients

Robert Apsner, MD*, Diego Gruber{dagger}, Walter H. Hörl, MD PhD, FRCP*, and Gere Sunder-Plassmann, MD*

*Department of Medicine III, Division of Nephrology and Dialysis, and {dagger}Department of Medical Statistics, University of Vienna, Vienna, Austria

Address correspondence and reprint requests to Robert Apsner, MD, Clinique St. Thérèse, L-2763 Luxembourg. Address e-mail to robert.apsner{at}akh-wien.ac.at

Regional citrate anticoagulation during extracorporeal treatment is used in patients at risk for hemorrhage. We conducted a prospective clinical trial on the effect of large- versus small-dose calcium supplementation during citrate anticoagulated hemodialysis on ionized calcium and intact parathyroid hormone (iPTH). Twenty-five treatments were studied in 25 patients with active bleeding or at risk for hemorrhage. Sixteen patients received large-dose calcium (15 mmol/h), and 9 received small-dose calcium (5 mmol/h) substitution during treatment. Ionized calcium increased in 13 of 16 patients in the large-dose calcium group and decreased in 8 of 9 patients in the small-dose calcium group. Intact PTH decreased by 25% in the large-dose group and increased by 121% in the small-dose group (P = 0.0007 for {Delta}; P = 0.007 for {Delta}%). In the 14 patients in whom ionized calcium increased, iPTH decreased. In 10 of 11 patients in whom ionized calcium decreased, iPTH increased. The increase or decrease of ionized calcium was more predictive for changes in iPTH than was the calcium-substitution rate (R2 = 0.5526 versus 0.3962, respectively). We conclude that the behavior of iPTH can be influenced in a predictive manner by adjusting the calcium-substitution rate during treatment.

IMPLICATIONS: Bleeding complications during extracorporeal detoxification procedures can be reduced if regional citrate anticoagulation is used instead of heparin. Citrate anticoagulation can induce important changes in the secretion of parathyroid hormone.






Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2004 by the International Anesthesia Research Society.