Automated regional citrate anticoagulation based on online monitoring of ionized calcium concentration: Proof of concept.
closed-loop control system
continuous renal replacement therapy
ion-selective electrode
ionized calcium
regional citrate anticoagulation
Journal
Artificial organs
ISSN: 1525-1594
Titre abrégé: Artif Organs
Pays: United States
ID NLM: 7802778
Informations de publication
Date de publication:
Nov 2022
Nov 2022
Historique:
revised:
03
06
2022
received:
27
04
2022
accepted:
08
06
2022
pubmed:
15
6
2022
medline:
2
11
2022
entrez:
14
6
2022
Statut:
ppublish
Résumé
Regional citrate anticoagulation (RCA), a complex and effective technique, is recommended as the anticoagulation of choice for continuous renal replacement therapy. One of its key objectives is to keep the ionized calcium in the targeted range. In this study, we aimed to develop an automated RCA based on online monitoring of the ionized calcium concentration and closed-loop feedback. We constructed calcium-selective electrodes with liquid inner contact, which measured a potentiometric signal as the output. We tested the responses, stability, and selectivity of the electrodes in flowing fluid containing calcium chloride. We compared the measurement accuracy between the electrodes and an i-STAT system in vivo. Moreover, we established closed-loop feedback using a proportional-integral-derivative controller model. We performed simulated automated RCA both in vivo and in vitro. The electrode gave a Nernstian response to the variation of ionized calcium concentration. It showed high stability and a relatively short response time. Changes in the fluid flow rate, solution PH, and addition of metal ions including Mg We successfully trialed automated RCA, which may help simplify the complexities of RCA in the future.
Sections du résumé
BACKGROUND
BACKGROUND
Regional citrate anticoagulation (RCA), a complex and effective technique, is recommended as the anticoagulation of choice for continuous renal replacement therapy. One of its key objectives is to keep the ionized calcium in the targeted range. In this study, we aimed to develop an automated RCA based on online monitoring of the ionized calcium concentration and closed-loop feedback.
METHODS
METHODS
We constructed calcium-selective electrodes with liquid inner contact, which measured a potentiometric signal as the output. We tested the responses, stability, and selectivity of the electrodes in flowing fluid containing calcium chloride. We compared the measurement accuracy between the electrodes and an i-STAT system in vivo. Moreover, we established closed-loop feedback using a proportional-integral-derivative controller model. We performed simulated automated RCA both in vivo and in vitro.
RESULTS
RESULTS
The electrode gave a Nernstian response to the variation of ionized calcium concentration. It showed high stability and a relatively short response time. Changes in the fluid flow rate, solution PH, and addition of metal ions including Mg
CONCLUSIONS
CONCLUSIONS
We successfully trialed automated RCA, which may help simplify the complexities of RCA in the future.
Substances chimiques
Citric Acid
2968PHW8QP
Calcium
SY7Q814VUP
Anticoagulants
0
Citrates
0
Ions
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2191-2200Subventions
Organisme : Shanghai Ninth People's Hospital Clinical Research Program
ID : JYLJ007
Organisme : National Natural Science Foundation of China
ID : 81470990
Organisme : National Natural Science Foundation of China
ID : 81870462
Organisme : Science & Technology Innovation fund of Shanghai Ninth People's Hospital
ID : CK2019010
Organisme : Science and Technology Commission of the Shanghai Municipality
ID : 17441904200
Organisme : Science and Technology Commission of the Shanghai Municipality
ID : 19441909300
Informations de copyright
© 2022 International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC.
Références
Joannidis M, Oudemans-van SH. Clinical review: patency of the circuit in continuous renal replacement therapy. Crit Care. 2007;11(4):218.
Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract. 2012;120(4):c179-84.
Buturovic-Ponikvar J. Is regional citrate anticoagulation the future of hemodialysis? Ther Apher Dial. 2016;20(3):234-9.
Kindgen-Milles D, Brandenburger T, Dimski T. Regional citrate anticoagulation for continuous renal replacement therapy. Curr Opin Crit Care. 2018;24(6):450-4.
Yu W, Zhuang F, Ma S, Fan Q, Zhu M, Ding F. Optimized calcium supplementation approach for regional citrate anticoagulation. Nephron. 2019;141(2):119-27.
Sharma MK, Wieringa FP, Frijns AJ, Kooman JP. On-line monitoring of electrolytes in hemodialysis: on the road towards individualizing treatment. Expert Rev Med Devices. 2016;13(10):933-43.
Burnett RW, Christiansen TF, Covington AK, Fogh-Andersen N, Külpmann WR, Lewenstam A, et al. IFCC recommended reference method for the determination of the substance concentration of ionized calcium in undiluted serum, plasma or whole blood. Clin Chem Lab Med. 2000;38(12):1301-14.
Gotch F, Evans M, Metzner K, Westphal D, Polaschegg H. An on-line monitor of dialyzer Na and K flux in hemodialysis. ASAIO Trans. 1990;36(3):M359-61.
Kirmizis D, Basile C. Calcium balance in hemodialysis: more uncertainty than certainty. Semin Dial. 2020;33:103-8.
Costa ESV, Caires RA, Bezerra JS, Costalonga EC, Oliveira APL, Coelho FO, et al. Use of regional citrate anticoagulation for continuous venovenous hemodialysis in critically ill cancer patients with acute kidney injury. J Crit Care. 2018;47:302-9.
Durão MS, Monte JC, Batista MC, Oliveira M, Iizuka IJ, Santos BF, et al. The use of regional citrate anticoagulation for continuous venovenous hemodiafiltration in acute kidney injury. Crit Care Med. 2008;36(11):3024-9.
Morgera S, Schneider M, Slowinski T, Vargas-Hein O, Zuckermann-Becker H, Peters H, et al. A safe citrate anticoagulation protocol with variable treatment efficacy and excellent control of the acid-base status. Crit Care Med. 2009;37(6):2018-24.
Hetzel GR, Taskaya G, Sucker C, Hennersdorf M, Grabensee B, Schmitz M. Citrate plasma levels in patients under regional anticoagulation in continuous venovenous hemofiltration. Am J Kidney Dis. 2006;48(5):806-11.
He H, Jenkins K, Lin C. A fluorescent chemosensor for calcium with excellent storage stability in water. Anal Chim Acta. 2008;611(2):197-204.
de Silva AP, Moody TS, Wright GD. Fluorescent PET (photoinduced electron transfer) sensors as potent analytical tools. Analyst. 2009;134(12):2385-93.
Zhao L, Jiang Y, Wei H, Jiang Y, Ma W, Zheng W, et al. In vivo measurement of calcium ion with solid-state ion-selective electrode by using shelled hollow carbon nanospheres as a transducing layer. Anal Chem. 2019;91(7):4421-8.
Boughton CK, Hovorka R. Is an artificial pancreas (closed-loop system) for type 1 diabetes effective? Diabet Med. 2019;36(3):279-86.
Ma R, Zhang B, Zhou Y, Li Z, Lei F. PID controller-guided attention neural network learning for fast and effective real photographs denoising. IEEE Trans Neural Netw Learn Syst. 2021. https://doi.org/10.1109/TNNLS.2020.3048031
West N, van Heusden K, Görges M, Brodie S, Rollinson A, Petersen CL, et al. Design and evaluation of a closed-loop anesthesia system with robust control and safety system. Anesth Analg. 2018;127(4):883-94.