Severa ipocalcemia conseguente all’assunzione orale di citrato in un paziente in emodialisi cronica



Parole chiave:

Hemodialysis, Hypocalcaemia, Oral Citrate, Parapharmaceuticals, Vascular access failure


We report a case of an 81-year-old man with end stage renal disease (ESRD) in chronic hemodialysis with severe hypocalcaemia secondary to the intake of a parapharmaceutical containing sodium and potassium citrate and in association with poor dialysis efficiency, due to malfunction of the vascular access, which promptly resolved after discontinuation of the supplement. The patient never showed signs or symptoms of hypocalcaemia. This case highlightens the importance of a correct pharmacological reconciliation in dialysis patients in order to avoid the onset of adverse events due to the uncontrolled intake of drugs or parapharmaceuticals.

Riferimenti bibliografici

Simpson DP. Citrate excretion: a window on renal metabolism. Am J Physiol. 1983;244(3):F223-F234. PMID:6338740

Hamm LL. Renal handling of citrate. Kidney Int. 1990;38(4):728-735. PMID:2232510

Costello LC, Franklin RB. Plasma citrate homeostasis: How it is regulated; and its physiological and clinical implications. An important, but neglected, relationship in medicine. HSOA J Hum Endocrinol. 2016;1: 005. PMID: 28286881

Tiselius HG, Berg C, Fornander AM, Nilsson MA. Effects of citrate on the different phases of calcium oxalate crystallization. Scanning Microsc. 1993;7(1):381-389. PMID:8316807

Seaton RD, Duncan KA, Pinnick RV, Diederich DA, Wiegmann TB. Regional citrate anticoagulation in chronic hemodialysis patients. Trans Am Soc Artif Intern Organs. 1983;29:414-418. PMID:6673262

Wolfgram DF, Gundu V, Astor BC, Jhagroo RA. Hydrochlorothiazide compared to chlorthalidone in reduction of urinary calcium in patients with kidney stones. Urolithiasis. 2013;41(4):315-322. PMID:23660825

Phillips R, Hanchanale VS, Myatt A, Somani B, Nabi G, Biyani CS. Citrate salts for preventing and treating calcium containing kidney stones in adults. Cochrane Database Syst Rev. 2015;(10):CD010057. PMID:26439475

Monchi M. Citrate pathophysiology and metabolism. Transfus Apheresis Sci. 2017;56(1):28-30. PMID:28073690

Olgaard K, Salusky IB, Silver J. The spectrum of mineral bone disorders in chronic kidney disease. 2nd ed.Oxford. Oxford University Press; 2010:111-114.



Come citare

Gallo M, Aterini S, Bandini S, Bergesio F, Ciciani AM, Aterini L, Calderini F, Balboni F. Severa ipocalcemia conseguente all’assunzione orale di citrato in un paziente in emodialisi cronica. G Clin Nefrol Dial [Internet]. 13 settembre 2021 [citato 11 agosto 2022];33(1):91-4. Available at:



Casi clinici

Puoi leggere altri articoli dello stesso autore/i

1 2 > >>