Applying Regional Citrate Anticoagulation in Continuous Renal Replacement Therapy for Acute Kidney Injury Patients with Acute Liver Dysfunction: a Retrospective Observational Study
Abstract:Background/Aims: Continuous renal replacement therapy (CRRT) is a treatment for acute kidney injury (AKI) patients. It has become a controversy about whether patients with liver dysfunction should perform CRRT with regional citrate anticoagulation (RCA). Methods: This retrospective observational study enrolled 145 AKI patients (275 CRRT sessions) who received CRRT with RCA and had no history of chronic liver disease. Circuit survival time, blood pressure, trans-membrane pressure (TMP), acid-base and electrolyt… Show more
“…Additionally, we got no responses after sending several letters to the authors of this paper. Finally, 10 studies [9–11, 18–24] with 1411 patients were included in this systematic review.Fig. 1Study inclusion flow chart…”
Section: Resultsmentioning
confidence: 99%
“…Five (50%) studies [9, 10, 18, 20, 21] conducted comparisons between different time points during RCA-CRRT (including 0–72 h, 0–24 h, 1–5 days, 1–7 days, and 0–7 days). Four (40%) studies [11, 19, 22, 24] compared data across groups divided by liver function. And two studies [23, 24] compared data between the groups with or without citrate accumulation.…”
Section: Resultsmentioning
confidence: 99%
“…Four (40%) studies [11, 19, 22, 24] compared data across groups divided by liver function. And two studies [23, 24] compared data between the groups with or without citrate accumulation.…”
Section: Resultsmentioning
confidence: 99%
“…Five studies [9, 11, 21–23] were scored 6–8 and were considered to be high-quality study. And the remaining 5 studies [10, 18–20, 24] were scored 4–5 and considered as moderate quality study.…”
Section: Resultsmentioning
confidence: 99%
“…Of the included studies, 8 [11, 18–24] reported the mean filter lifespan with a median of 55.9 h (IQR 32.8 to 68.9). And the minimum and maximum mean filter lifespan were 22.7 h [21] and 72 h [19], respectively (Table 2).…”
BackgroundRegional citrate anticoagulation (RCA) is a widely used strategy for continuous renal replacement therapy (CRRT). Most of the current guidelines recommend liver failure as one of the contraindications for citrate anticoagulation. However, some studies suggested that the use of citrate for CRRT in liver failure patients did not increase the risk of citrate-related complications. The purpose of this systematic review is to summarize the current evidences on the safety and efficacy of RCA for CRRT in liver failure patients.MethodsWe performed a comprehensive search on PubMed, Embase, and the Cochrane Library databases from the inception to March 1, 2018. Studies enrolled adult (age > 18 years) patients with various levels of liver dysfunction underwent RCA-CRRT were included in this systematic review.ResultsAfter the study screening, 10 observational studies with 1241 liver dysfunction patients were included in this systematic review. The pooled rate of citrate accumulation and bleeding was 12% [3%, 22%] and 5% [2%, 8%], respectively. Compared with the baseline data, the serum pH, bicarbonate, and base excess (BE), the rate of metabolic alkalosis, the serum ionized calcium (ionCa) and total calcium (totCa) level, and the ratio of total calcium/ionized calcium (totCa/ionCa) significantly increased at the end of observation. However, no significant increase was observed in serum citrate (MD − 65.82 [− 194.19, 62.55]), lactate (MD 0.49 [− 0.27, 1.26]) and total bilirubin concentration (MD 0.79 [− 0.70, 2.29]) at the end of CRRT. Compared with non-liver failure patients, the live failure patients showed no significant difference in the pH (MD − 0.04 [− 0.13, 0.05]), serum lactate level (MD 0.69 [− 0.26, 1.64]), and totCa/ionCa ratio (MD 0.03 [− 0.12, 0.18]) during CRRT. The median of mean filter lifespan was 55.9 h, with a range from 22.7 to 72 h.ConclusionsRegional citrate anticoagulation seems to be a safe anticoagulation method in liver failure patients underwent CRRT and could yield a favorable filter lifespan. Closely monitoring the acid base status and electrolyte balance may be more necessary during RCA-CRRT in patients with liver failure.Electronic supplementary materialThe online version of this article (10.1186/s13054-019-2317-9) contains supplementary material, which is available to authorized users.
“…Additionally, we got no responses after sending several letters to the authors of this paper. Finally, 10 studies [9–11, 18–24] with 1411 patients were included in this systematic review.Fig. 1Study inclusion flow chart…”
Section: Resultsmentioning
confidence: 99%
“…Five (50%) studies [9, 10, 18, 20, 21] conducted comparisons between different time points during RCA-CRRT (including 0–72 h, 0–24 h, 1–5 days, 1–7 days, and 0–7 days). Four (40%) studies [11, 19, 22, 24] compared data across groups divided by liver function. And two studies [23, 24] compared data between the groups with or without citrate accumulation.…”
Section: Resultsmentioning
confidence: 99%
“…Four (40%) studies [11, 19, 22, 24] compared data across groups divided by liver function. And two studies [23, 24] compared data between the groups with or without citrate accumulation.…”
Section: Resultsmentioning
confidence: 99%
“…Five studies [9, 11, 21–23] were scored 6–8 and were considered to be high-quality study. And the remaining 5 studies [10, 18–20, 24] were scored 4–5 and considered as moderate quality study.…”
Section: Resultsmentioning
confidence: 99%
“…Of the included studies, 8 [11, 18–24] reported the mean filter lifespan with a median of 55.9 h (IQR 32.8 to 68.9). And the minimum and maximum mean filter lifespan were 22.7 h [21] and 72 h [19], respectively (Table 2).…”
BackgroundRegional citrate anticoagulation (RCA) is a widely used strategy for continuous renal replacement therapy (CRRT). Most of the current guidelines recommend liver failure as one of the contraindications for citrate anticoagulation. However, some studies suggested that the use of citrate for CRRT in liver failure patients did not increase the risk of citrate-related complications. The purpose of this systematic review is to summarize the current evidences on the safety and efficacy of RCA for CRRT in liver failure patients.MethodsWe performed a comprehensive search on PubMed, Embase, and the Cochrane Library databases from the inception to March 1, 2018. Studies enrolled adult (age > 18 years) patients with various levels of liver dysfunction underwent RCA-CRRT were included in this systematic review.ResultsAfter the study screening, 10 observational studies with 1241 liver dysfunction patients were included in this systematic review. The pooled rate of citrate accumulation and bleeding was 12% [3%, 22%] and 5% [2%, 8%], respectively. Compared with the baseline data, the serum pH, bicarbonate, and base excess (BE), the rate of metabolic alkalosis, the serum ionized calcium (ionCa) and total calcium (totCa) level, and the ratio of total calcium/ionized calcium (totCa/ionCa) significantly increased at the end of observation. However, no significant increase was observed in serum citrate (MD − 65.82 [− 194.19, 62.55]), lactate (MD 0.49 [− 0.27, 1.26]) and total bilirubin concentration (MD 0.79 [− 0.70, 2.29]) at the end of CRRT. Compared with non-liver failure patients, the live failure patients showed no significant difference in the pH (MD − 0.04 [− 0.13, 0.05]), serum lactate level (MD 0.69 [− 0.26, 1.64]), and totCa/ionCa ratio (MD 0.03 [− 0.12, 0.18]) during CRRT. The median of mean filter lifespan was 55.9 h, with a range from 22.7 to 72 h.ConclusionsRegional citrate anticoagulation seems to be a safe anticoagulation method in liver failure patients underwent CRRT and could yield a favorable filter lifespan. Closely monitoring the acid base status and electrolyte balance may be more necessary during RCA-CRRT in patients with liver failure.Electronic supplementary materialThe online version of this article (10.1186/s13054-019-2317-9) contains supplementary material, which is available to authorized users.
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