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A Randomized Trial Comparing the Bowel Cleansing Efficacy of Sodium Picosulfate/Magnesium Citrate and Polyethylene Glycol/Bisacodyl (The Bowklean Study).
Hung, SY, Chen, HC, Chen, WT
Scientific reports. 2020;(1):5604
Abstract
Bowel cleansing is essential for a successful colonoscopy, but the ideal clearing agent and the volume have yet to be determined. A small-volume cleanser is important for patient compliance. This study aimed to compare the bowel cleansing efficacy, safety, tolerability, and acceptability of a 300-mL small-volume sodium picosulfate/magnesium citrate (PSMC) preparation-Bowklean with one 2-L polyethylene glycol (PEG)/bisacodyl-Klean-Prep/Dulcolax preparation under identical dietary recommendations. This multicenter, randomized, parallel-group, pre-specified noninferiority study enrolled 631 outpatients scheduled to undergo colonoscopy (Bowklean = 316 and Klean-Prep/Dulcolax = 315). After bowel preparation, an independent evaluator blinded to the subject's treatment allocation rated the quality of the colon cleansing. Efficacy was evaluated using the Aronchick Scale and Ottawa Bowel Preparation Scale (OPBS). Safety was assessed by monitoring adverse events. Tolerability and acceptability were measured via a patient questionnaire. Bowklean was non-interior to Klean-Prep/Dulcolax in overall colon cleansing but was associated with significantly better preparation quality. Notably, Bowklean was associated with significantly greater tolerability and acceptability of bowel preparations than Klean-Prep/Dulcolax. Safety profiles did not differ significantly between the groups. Our data indicate that Bowklean is a more effective and better-tolerated bowel cleansing preparation before colonoscopy than Klean-Prep/Dulcolax. Bowklean may therefore increase positive attitudes toward colonoscopies and participation rates.
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2.
Haemodialysis with Tinzaparin Versus Dialysate Citrate as Anticoagulation.
Mahmood, D, Stegmayr, BG
Blood purification. 2018;(3):257-263
Abstract
Anticoagulation with citrate-containing haemodialysate (cHD) is an alternative to tinzaparin haemodialysate (tHD). The study investigated whether cHD would differ when changed from tHD. The same 18 patients were their own controls followed up with cHD for 5 months. LDL-cholesterol decreased at the end of a cHD session (p = 0.01). Neutrophils (p = 0.013) and monocytes (p = 0.007) dropped more during a cHD session. During the follow-up period of cHD, approximately 50% needed additional tinzaparin. Before the cHD session could start, there was a lower total cholesterol at 2 weeks (p = 0.014) and LDL-cholesterol at 1 month (p = 0.011) versus an increase of LDL at 5 months (p = 0.02). Only patients without additional tinzaparin had a reduction of -C-reactive protein (CRP) at 2 months of cHD (p < 0.05) but not later. Solely cHD seems possible only in half of the patients. A greater reduction in granulocytes and monocytes during cHD indicates a more extensive blood membrane interaction, while CRP may be lower.
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3.
Simple citrate anticoagulation protocol for low flux haemodialysis.
Lim, EK, Seow, YT, Chen, SE, Yang, G, Liaw, ME, Isaac, S
BMC nephrology. 2018;(1):16
Abstract
BACKGROUND For patients unable to receive heparin anticoagulation during haemodialysis, saline flushes to reduce circuit clotting are often the norm. Regional citrate anticoagulation (RCA) although effective is not used by many centres including in Singapore. We wanted to demonstrate the superiority and safety of a simple regional citrate anticoagulation regime, compared to saline flushes, for heparin-free low flux haemodialysis. METHODS This is a prospective, open label, cross over study on 25 sequential haemodialysis sessions for inpatients receiving heparin-free haemodialysis. Patients were allocated either to regional citrate anticoagulation or standard heparin free haemodialysis and subsequently cross over to the alternate method. RCA was carried out using a protocol derived from previous studies. Assessment of anticoagulation was performed using visual inspection of clot formation in dialysis circuits and post-filter ionized calcium (iCa2+) using point-of-care Ionized calcium device at stipulated intervals. Intravenous Calcium gluconate replacement was given to patients receiving citrate adjusting the rate according to pre-filter iCa2+. Laboratory analyses of electrolytes were also assessed at the start and end of the RCA sessions. RESULTS There were no clots in the RCA arm, with 79% (n = 19) in the saline flush arm having some clot, including 1 clotted circuit. Post-filter iCa2+ at various time points were within acceptable range. Electrolyte readings in the RCA group were all within normal limits except for 4 cases of total Calcium:iCa2+ ratio > 2.5. CONCLUSION RCA is confirmed to be superior to saline flushes for circuit patency. We have a simple and safe protocol that can be followed for low flux haemodialysis. The study was approved by Singapore National Health Group domain-specific ethnical committee. NHG DSRB reference number 2014/01037. TRIAL REGISTRATION Trial registration number: ISRCTN69952745 (registration date 8/11/17).
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The efficacy of "Abound™," a nutritional supplement containing L-glutamine, L-arginine, citric acid, and calcium HMB, for skin disorders that developed as adverse drug reactions to anti-EGFR antibody preparation administration: pilot study.
Matsuhashi, N, Takahashi, T, Tanahashi, T, Matsui, S, Sasaki, Y, Tanaka, Y, Okumura, N, Yamaguchi, K, Osada, S, Yoshida, K
International journal of colorectal disease. 2016;(5):1055-1057
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[Role of local citrate anticoagulation in continuous blood purification to patients at high risk of bleeding in ICU].
Zhao, S, Ou, H, Peng, Y, Liu, Z, Yang, M, Xiao, X
Zhong nan da xue xue bao. Yi xue ban = Journal of Central South University. Medical sciences. 2016;(12):1334-1339
Abstract
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.
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6.
Regional citrate anticoagulation for pediatric CRRT using integrated citrate software and physiological sodium concentration solutions.
Liet, JM, Allain-Launay, E, Gaillard-LeRoux, B, Barrière, F, Chenouard, A, Dejode, JM, Joram, N
Pediatric nephrology (Berlin, Germany). 2014;(9):1625-31
Abstract
BACKGROUND In continuous renal replacement therapy (CRRT), regional citrate anticoagulation offers an attractive alternative to heparinization, especially for children with a high bleeding risk. METHODS We report on a new management approach to CRRT using integrated citrate software and physiological sodium concentration solutions. Convective filtration was performed with pre-filter citrate anticoagulation using an 18 mmol/L citrate solution and a post-filter replacement fluid. The citrate flow rate was automatically adjusted to the blood flow rate by means of integrated citrate software. Similarly, calcium was automatically infused into children to maintain their blood calcium levels within normal range. RESULTS Eleven CRRT sessions were performed (330 h) in seven critically ill children aged 3-15 years (extreme values 15-66 kg). Disease categories included sepsis with multiorgan dysfunction (n = 2) and hemolytic uremic syndrome (n = 5). Median effluent dose was 2.1 (extreme values 1.7-3.3) L/h/1.73 m2. No session had to be stopped because of metabolic complications. Calcium levels, both in the circuits and in the circulating blood of the children, remained stable and secure. CONCLUSIONS Regional citrate anticoagulation can be used in children with a body weight of >15 kg using integrated citrate software and commercially available solutions with physiological sodium concentrations in a safe, effective and convenient procedure.
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Post-dilution on line haemodiafiltration with citrate dialysate: first clinical experience in chronic dialysis patients.
Panichi, V, Fiaccadori, E, Rosati, A, Fanelli, R, Bernabini, G, Scatena, A, Pizzarelli, F
TheScientificWorldJournal. 2013;:703612
Abstract
BACKGROUND Citrate has anticoagulative properties and favorable effects on inflammation, but it has the potential hazards of inducing hypocalcemia. Bicarbonate dialysate (BHD) replacing citrate for acetate is now used in chronic haemodialysis but has never been tested in postdilution online haemodiafiltration (OL-HDF). METHODS Thirteen chronic stable dialysis patients were enrolled in a pilot, short-term study. Patients underwent one week (3 dialysis sessions) of BHD with 0.8 mmol/L citrate dialysate, followed by one week of postdilution high volume OL-HDF with standard bicarbonate dialysate, and one week of high volume OL-HDF with 0.8 mmol/L citrate dialysate. RESULTS In citrate OL-HDF pretreatment plasma levels of C-reactive protein and β 2-microglobulin were significantly reduced; intra-treatment plasma acetate levels increased in the former technique and decreased in the latter. During both citrate techniques (OL-HDF and HD) ionized calcium levels remained stable within the normal range. CONCLUSIONS Should our promising results be confirmed in a long-term study on a wider population, then OL-HDF with citrate dialysate may represent a further step in improving dialysis biocompatibility.
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Efficacy of preventing hemodialysis catheter infections with citrate lock.
Silva, J, Antunes, J, Carvalho, T, Ponce, P
Hemodialysis international. International Symposium on Home Hemodialysis. 2012;(4):545-52
Abstract
Prevalent use of tunneled dialysis catheters can reach 30%. Infection remains the most serious catheter-related problem. Catheter locks are increasingly used for prevention, but are not yet recommended either by the Food and Drug Association or European Medicines Agency, on the basis of increasing bacterial resistance or lock toxicity. The aim was to test safety and effectiveness of citrate. A prospective, interventional study was conducted to assess the safety and efficacy of a 30% citrate lock in preventing catheter-related bacteremia (CRB). A total of 157 prevalent tunneled catheters were locked with citrate and prospectively followed during a 1-year period. The primary endpoint was first CRB diagnosed according to two of the diagnostic criteria for Catheter Infection of Centers for Disease Control and Prevention (CDC), namely definite and probable infection. The CDC criterion of possible but not proved infection was not considered. This citrate lock cohort (n = 157) had 10 episodes of CRB. We observed 0.49 CRB episodes/1000 patient-days and the mean infection-free catheter day was 130.6 ± 100.9. No clinically relevant adverse events were observed. No proved tunnel or exit site infection was observed and no patients died because of CRB. Catheter obstruction episodes were reported on 69 occasions out of 14 catheters. These results were compared with an historical cohort from a previous study of catheter locking with low-dose gentamicin and did not show significant difference in efficacy. Citrate lock is effective in preventing CRB. No toxicity was observed. The use of citrate lock may have advantages over antibiotic locks: no reported bacterial resistance, lower industrial cost, and less manipulation.
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Metabolic effects of citrate- vs bicarbonate-based substitution fluid in continuous venovenous hemofiltration: a prospective sequential cohort study.
Aman, J, Nurmohamed, SA, Vervloet, MG, Groeneveld, AB
Journal of critical care. 2010;(1):120-7
Abstract
BACKGROUND Studies investigating the metabolic effects of citrate-based substitution fluids are lacking. This study aims to compare the effect of citrate- vs bicarbonate-based substitution fluid used during continuous venovenous hemofiltration (CVVH) for acute kidney injury on acid-base balance and electrolytes in critically ill patients. METHODS This was a prospective sequential cohort study in patients with a contraindication for systemic anticoagulation. The first cohort was treated by bicarbonate-based CVVH (n = 10) and the second cohort was treated by CVVH with citrate-based substitution fluid (n = 19). Flow of the latter was coupled to blood flow, and ionized calcium concentrations were monitored and kept constant by calcium-glubionate infusion. RESULTS No major differences between the 2 groups were found in baseline acid-base parameters. In both groups, arterial pH increased after initiation of treatment and normalized on the average within 18 hours in either group. No differences were found in bicarbonate concentrations. Electrolyte control was comparable for the groups. CONCLUSION Citrate-based substitution fluid is comparable to bicarbonate-based substitution fluid during CVVH in critically ill patients with acute kidney injury, concerning acid-base balance and electrolyte control. This implies complete conversion of citrate to bicarbonate in the patients studied.
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10.
[The use of simplified regional citrate anticoagulation in continuous veno-venous hemofiltration].
Chen, SY, Wan, JX, Wu, BD
Zhongguo wei zhong bing ji jiu yi xue = Chinese critical care medicine = Zhongguo weizhongbing jijiuyixue. 2010;(5):313-6
Abstract
OBJECTIVE To study the safety and effect of simplified regional citrate anticoagulation (RCA) in continuous veno-venous hemofiltration (CVVH). METHODS Fourteen patients were treated with CVVH using simplified RAC. Simplified anticoagulation protocol included the addition of 4% sodium citrate into the replacement fluid. The citrate replacement fluid was infused in a speed of 2,000 ml/h or 3,000 ml/h, and at the same time 10% calcium gluconate and 25% magnesium sulfate were infused post filter or with venous pump into peripheral veins. Serum electrolytes, arterial blood gas analysis, coagulation at the beginning and 4, 8, 12 hours after the treatment were monitored. Patient's general condition was observed carefully. After treatment, blood volume in the hollow fiber filter was measured. RESULTS Fourteen patients underwent altogether 34 times of this procedure for a total of 544 hours. Each treatment lasted 4-36 hours, with a mean of (16.0+/-7.5) hours. The filter was not changed for 30 procedures. After treatment, the blood volume in the filter was higher than 80% of the original volume. The life span of the filter was (14.79+/-5.98) hours on the average. Twelve hours after infusing citrate, there was a marked shortening of prothrombin time [PT, (12.2+/-1.2) s vs. (14.0+/-3.3) s], while plasma total calcium was increased markedly [(2.46+/-0.30) mmol/L vs. (2.07+/-0.36) mmol/L, both P<0.05]. There was no significant difference in activated partial thromboplastin time (APTT), thrombin time (TT), the concentration of Ca(2+) and Mg(2+), pH and base excess (BE). In one patient with hypoxemia the treatment was stopped due to the appearance of serious complications. No hypernatremia or metabolic alkalosis was found during the RCA in all the patients. No significant bleeding events attributed to RCA occurred. CONCLUSION The simplified anticoagulation protocol by adding sodium citrate replacement fluid can be applied safely in replacement fluid>2,000 ml/h of CVVH without complications of hypernatremia and metabolic alkalosis caused by sodium citrate anticoagulation.