{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T21:11:33Z","timestamp":1778965893507,"version":"3.51.4"},"reference-count":11,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2022,6,6]],"date-time":"2022-06-06T00:00:00Z","timestamp":1654473600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,6,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Regional citrate anticoagulation (RCA) is an option but citrate accumulation is risk and it is a giving up cause for this situation. This retrospective study was conducted in the pediatric intensive care unit (PICU) between May 2019 and April 2021. We investigated 47 patients with liver failure (LF) in our PICU, and RCA during continuous renal replacement therapy (CRRT) was applied to 10 (21.3%) of them. Half of them were male (n: 5\/10), their mean age was 104.7\u2009\u00b1\u200966.20\u2009months. Nine of them needed vasoactive support during follow-up. The most common indication for CRRT was hepatorenal syndrome (40%). There was no significant difference between liver transaminases and liver function tests before and after CRRT (p\u2009&amp;gt;\u20090.05). In terms of citrate toxicity of the patients, there was no significant difference between total calcium\/ionized calcium, lactate level, pH and bicarbonate values before and after CRRT (p\u2009&amp;gt;\u20090.05). The mean total CRRT time was 110.2\u2009\u00b1\u2009118.2\u2009h, and the mean circuit lifespan was 43.8\u2009\u00b1\u200948.7\u2009h; the mean number of circuits was 2.7\u2009\u00b1\u20092.4. Total Ca\/ionized Ca &amp;gt;2.5 was a clinically relevant endpoint, but no patient interrupted dialysis for this cause. There was no complication about RCA. This study did not observe any adverse effects on acid\u2013base status, transaminases, an increase in bilirubin during RCA\u2013CRRT treatment in pediatric patients with LF. Total calcium\/ionized calcium ratio, serum lactate level and prothrombin time level should be closely monitored daily in terms of citrate accumulation in this patient group.<\/jats:p>","DOI":"10.1093\/tropej\/fmac048","type":"journal-article","created":{"date-parts":[[2022,6,23]],"date-time":"2022-06-23T20:00:59Z","timestamp":1656014459000},"source":"Crossref","is-referenced-by-count":6,"title":["Continuous Renal Replacement Therapy with Regional Citrate Anticoagulation in Children with Liver Dysfunction\/Failure"],"prefix":"10.1093","volume":"68","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4586-1595","authenticated-orcid":false,"given":"Edin","family":"Botan","sequence":"first","affiliation":[{"name":"Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University School of Medicine , Ankara, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ay\u015fen","family":"Durak","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Ankara University School of Medicine , Ankara, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7337-0190","authenticated-orcid":false,"given":"Emrah","family":"G\u00fcn","sequence":"additional","affiliation":[{"name":"Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University School of Medicine , Ankara, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1383-5130","authenticated-orcid":false,"given":"Anar","family":"Gurbanov","sequence":"additional","affiliation":[{"name":"Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University School of Medicine , Ankara, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6636-2678","authenticated-orcid":false,"given":"Burak","family":"Balaban","sequence":"additional","affiliation":[{"name":"Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University School of Medicine , Ankara, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fevzi","family":"Kahveci","sequence":"additional","affiliation":[{"name":"Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University School of Medicine , Ankara, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2349-1602","authenticated-orcid":false,"given":"Hasan","family":"\u00d6zen","sequence":"additional","affiliation":[{"name":"Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University School of Medicine , Ankara, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2927-2360","authenticated-orcid":false,"given":"Hacer","family":"U\u00e7mak","sequence":"additional","affiliation":[{"name":"Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University School of Medicine , Ankara, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fulden","family":"Aycan","sequence":"additional","affiliation":[{"name":"Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University School of Medicine , Ankara, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9458-2803","authenticated-orcid":false,"given":"Tan\u0131l","family":"Kendirli","sequence":"additional","affiliation":[{"name":"Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University School of Medicine , Ankara, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2022,6,23]]},"reference":[{"key":"2022062320005323500_fmac048-B1","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1097\/MPG.0b013e3182349a04","article-title":"Pediatric end-stage liver disease score in acute liver failure to assess poor prognosis","volume":"54","author":"Sanchez","year":"2012","journal-title":"J Pediatr Gastroenterol Nutr"},{"key":"2022062320005323500_fmac048-B2","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1111\/1744-9987.12331","article-title":"Transition from heparin to citrate anticoagulation for continuous renal replacement therapy: safety, efficiency, and cost","volume":"20","author":"Anstey","year":"2016","journal-title":"Ther Apher Dial"},{"key":"2022062320005323500_fmac048-B3","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13054-017-1880-1","article-title":"Complications of regional citrate anticoagulation: accumulation or overload?","volume":"21","author":"Schneider","year":"2017","journal-title":"Crit Care"},{"key":"2022062320005323500_fmac048-B4","author":"Mehta"},{"key":"2022062320005323500_fmac048-B5","doi-asserted-by":"crossref","first-page":"c131","DOI":"10.1159\/000079171","article-title":"Metabolic complications during regional citrate anticoagulation in continuous venovenous hemodialysis: single-center experience","volume":"97","author":"Morgera","year":"2004","journal-title":"Nephron Clin Pract"},{"key":"2022062320005323500_fmac048-B6","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13054-015-1066-7","article-title":"Safety and efficacy of regional citrate anticoagulation in continuous venovenous hemodialysis in the presence of liver failure: the Liver Citrate Anticoagulation Threshold (L-CAT) observational study","volume":"19","author":"Slowinski","year":"2015","journal-title":"Crit Care"},{"key":"2022062320005323500_fmac048-B7","doi-asserted-by":"crossref","first-page":"R97","DOI":"10.1186\/cc11363","article-title":"Total-to-ionized calcium ratio predicts mortality in continuous renal replacement therapy with citrate anticoagulation in critically ill patients","volume":"16","author":"Link","year":"2012","journal-title":"Crit Care"},{"key":"2022062320005323500_fmac048-B8","doi-asserted-by":"crossref","first-page":"R162","DOI":"10.1186\/cc11485","article-title":"Continuous venovenous hemodialysis with regional citrate anticoagulation in patients with liver failure: a prospective observational study","volume":"16","author":"Schulthei\u00df","year":"2012","journal-title":"Crit Care"},{"key":"2022062320005323500_fmac048-B9","doi-asserted-by":"crossref","first-page":"748","DOI":"10.1097\/00003246-200104000-00010","article-title":"Increased total to ionized calcium ratio during continuous venovenous hemodialysis with regional citrate anticoagulation","volume":"29","author":"Meier-Kriesche","year":"2001","journal-title":"Crit Care Med"},{"key":"2022062320005323500_fmac048-B10","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13054-019-2317-9","article-title":"Safety and efficacy of regional citrate anticoagulation for continuous renal replacement therapy in liver failure patients: a systematic review and meta-analysis","volume":"23","author":"Zhang","year":"2019","journal-title":"Crit Care"},{"key":"2022062320005323500_fmac048-B11","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1016\/j.jhep.2009.05.028","article-title":"Continuous renal replacement therapy (CRRT) in patients with liver disease: is circuit life different?","volume":"51","author":"Agarwal","year":"2009","journal-title":"J Hepatol"}],"container-title":["Journal of Tropical 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