Albumin-corrected total/ionized calcium ratio is not superior to total/ionized calcium ratio as an indicator of citrate accumulation



Total/ionized calcium ratio has been used as an indirect index of increased plasma citrate concentration during citrate anticoagulation. However, they were obtained without any adjustment of total calcium for albumin. Herein, we investigated whether the albumin-corrected total/ionized calcium ratio performed better than total/ionized calcium ratio.


20 critically ill patients were treated with continuous venovenous hemofiltration (CVVH) using citrate anticoagulation. The systemic total, ionized calcium and albumin levels were dynamically measured, and correlations between different calcium parameters and plasma citrate levels were analyzed.


The highest correlation was found between plasma citrate level and total/ionized calcium ratio at the third hour (R = 0.88, p<0.001). The albumin-corrected total/ionized calcium ratio was not superior to total/ionized calcium ratio.


The total/ionized calcium ratio at the third hour after the start of citrate-CVVH is an early and simple indicator to reflect increased plasma citrate level. Adjustment of systemic total calcium for serum albumin is not necessary.

Int J Artif Organs 2017; 40(11): 602 - 606




Yin Zheng, Feng Zhuang, Qiuyu Zhu, Shuai Ma, Yao Xu, Jianxin Lu, Guihua Hao, Yong Gu, Chuanming Hao, Mingli Zhu, Feng Ding

Article History


Financial support: This study was supported, in part, by grants from National Natural Science Foundation of China (No: 81070609, 81270850, and 81470990), the Science and Technology Commission of Shanghai Municipality (No: 11441901401), the National Key Technology R&D Program (No: 2011BAI10B08), Shanghai Pudong New Area Program (No: PW2015D-4), Shanghai Jiaotong University Key Program (YG2014ZD06) (to F. D.), and the Scientific Research Foundation of Huashan North Hospital (to Y.Z.).
Conflict of interest: None of the authors has financial interest for this study to disclose.

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  • Division of Nephrology, Huashan Hospital, Fudan University, Shanghai - China
  • Division of Nephrology and Unit of Critical Care Nephrology, Shanghai Ninth People’s Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai - China
  • Division of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai - China
  • Yin Zheng and Feng Zhuang contributed equally to this study.

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