Citrate pharmacokinetics and calcium levels during high-flux dialysis with regional citrate anticoagulation

Background. Regional citrate anticoagulation is a very effective anticoagulation method for haemodialysis. However, it is not widely used, primarily due to the risk of hypocalcaemia. We studied citrate and calcium kinetics to better understand safety aspects of this anticoagulation method

Social space oriented family work - new methods of action in out-of-home care? A social space-oriented view according to Wolfgang Hinte on family work in the context of out-of-home placement

Diese Bachelorarbeit untersucht, wie ein sozialräumlicher Blick, basierend auf den fünf Prinzipien von Hinte, neue Handlungsmöglichkeiten in der Familienarbeit, speziell bei Bezugspersonen von Kindern, die fremduntergebracht sind für die Soziale Arbeit bieten kann. Ziel dieser Literaturrecherche ist es, auf eine bestehende Lücke in der Fachliteratur aufmerksam zu machen und erste Lösungsvorschläge zu liefern. Zu diesem Zweck werden die Hindernisse der Familienarbeit mit dem Fachkonzept Sozialraumorientierung in Bezug gesetzt. Daraus ergibt sich, dass die handlungsleitenden Prinzipien wie Anerkennung des Willens, aktivierende Haltung, Ressourcenorientiertheit, ziel- und bereichsübergreifende Arbeiten und Vernetzung, Basis einer gelingenden Familienarbeit sein können. Limitationen dieser Arbeit sind begrenzte Fachliteratur und fehlende eigene empirische Erhebung von Daten. Dennoch bietet sie Grundlage für zukünftige Forschungsarbeiten und Denkanstöße zu alternativen Handlungsoptionen.This bachelor thesis examines how a socio-spatial view, based on Hinte's five principles, can offer new possibilities for action in family work, especially for caregivers of children in out-of-home care. The aim of this literature review is to draw attention to an existing research gap and to provide initial suggestions for solutions. For this purpose, the obstacles of family work are put into relation with the professional concept of social space orientation. The findings of this study suggest that action-guiding principles such as recognition of the will, activating attitude, resource-orientation, goal- and area-overlapping work and networking, can be the basis of successful family work. Limitations of this work are the limited literature and the lack of empirical data. Nevertheless, it offers a basis for future research and provides impulses for on alternative action strategies

Citrate- vs. acetate-based dialysate in bicarbonate haemodialysis: consequences on haemodynamics, coagulation, acid-base status, and electrolytes.

BACKGROUND: A concentrate for bicarbonate haemodialysis acidified with citrate instead of acetate has been marketed in recent years. The small amount of citrate used (one-fifth of the concentration adopted in regional anticoagulation) protects against intradialyser clotting while minimally affecting the calcium concentration. The aim of this study was to compare the impact of citrate- and acetate-based dialysates on systemic haemodynamics, coagulation, acid-base status, calcium balance and dialysis efficiency. METHODS: In 25 patients who underwent a total of 375 dialysis sessions, an acetate dialysate (A) was compared with a citrate dialysate with (C+) or without (C) calcium supplementation (0.25 mmol/L) in a randomised single-blind cross-over study. Systemic haemodynamics were evaluated using pulse-wave analysis. Coagulation, acid-base status, calcium balance and dialysis efficiency were assessed using standard biochemical markers. RESULTS: Patients receiving the citrate dialysate had significantly lower systolic blood pressure (BP) (-4.3 mmHg, p < 0.01) and peripheral resistances (PR) (-51 dyne.sec.cm-5, p < 0.001) while stroke volume was not increased. In hypertensive patients there was a substantial reduction in BP (-7.8 mmHg, p < 0.01). With the C+ dialysate the BP gap was less pronounced but the reduction in PR was even greater (-226 dyne.sec.cm-5, p < 0.001). Analyses of the fluctuations in PR and of subjective tolerance suggested improved haemodynamic stability with the citrate dialysate. Furthermore, an increase in pre-dialysis bicarbonate and a decrease in pre-dialysis BUN, post-dialysis phosphate and ionised calcium were noted. Systemic coagulation activation was not influenced by citrate. CONCLUSION: The positive impact on dialysis efficiency, acid-base status and haemodynamics, as well as the subjective tolerance, together indicate that citrate dialysate can significantly contribute to improving haemodialysis in selected patients