Regional citrate anticoagulation for continuous renal replacement therapy

Abstract

Purpose of review The delivery of an effective dialysis dose in continuous renal replacement therapy (CRRT) depends on adequate anticoagulation of the extracorporeal circuit. In most patients, either systemic heparin anticoagulation (SHA) or regional citrate anticoagulation (RCA) is used. This review will outline the basics and rationale of RCA and summarize data on safety and efficacy of both techniques. Recent findings The basic principle of RCA is to reduce the level of ionized calcium in the extracorporeal circuit via infusion of citrate. This way, effective anticoagulation restricted to the extracorporeal circuit is achieved. SHA and RCA were compared in a variety of studies. RCA significantly prolonged filter lifetime, reduced bleeding complications and provided excellent control of uremia and acid-base status. RCA was also safe in the majority of patients with impaired liver function, whereas caution must be exerted in those with severe multiorgan failure and persistent hyperlactatemia. Summary RCA per se is safe and effective for anticoagulation of CRRT. Compared to SHA, efficacy of anticoagulation is improved and adverse effects are reduced. RCA can be recommended as the anticoagulation mode of choice for CRRT in most ICU patients.

Simplified Regional Citrate Anticoagulation Using a Calcium-Containing Replacement Solution for Continuous Renal Replacement Therapy: A Randomized Controlled Trial

“…No other adverse complications were seen in either group. Patients in our study had rare adverse reactions and this is in concordance with previous studies [32]. Simpli ed regional citrate anticoagulation using a calcium-containing replacement solution, as well as calcium-free replacement solution are safe protocols for usual clinical practice.…”

Prescription of CRRT: a pathway to optimize therapy

“…Regional citrate anticoagulation has been shown to be safe and effective for anticoagulation of CRRT in most ICU patients [14]. It is based on the ability of citrate to prevent coagulation in the extracorporeal circuit by binding and chelating free ionized calcium, which is a critical co-factor in both the intrinsic and extrinsic coagulation cascades.…”

Citrate-Based Self-Circulation Anticoagulation Protocol for Discontinuity of Continuous Renal Replacement Therapy

“…This therapy usually has a duration of hours or even days. However, this therapy often has to be temporarily discontinued, for necessary diagnostic examinations or surgery, and the transfusion of different blood products, because the risk of clot formation in bloodlines and filters during transfusion is high [4,5]. Although several potential strategies are available for dealing with this dilemma, little research has focused on the issue of how anticoagulation should be performed in children during the periods of CRRT discontinuity.…”