Regional citrate versus systemic heparin anticoagulation for continuous renal replacement therapy in critically ill children

Abstract

Objectives: Anticoagulation is used to prevent filter clotting in patients undergoing continuous renal replacement therapy. Regional citrate anticoagulation is associated with lower rates of bleeding complications and prolongs the filter life span; however, a number of metabolic side effects had been associated with this therapy. The aim of this study was to evaluate the effect and safety of citrate versus heparin anticoagulation for continuous renal replacement therapy in critically ill children. Methods: A retrospective comparative cohort study. Department of Pediatric Intensive Care, Acibadem Mehmet Ali Aydınlar University School of Medicine. Results: From August 2016 to August 2018, 45 patients (19 in the citrate group and 26 in the heparin group) were included. A total of 101 hemofilters were used in all therapies: 44 in the citrate group (total continuous renal replacement therapy time: 2699 h) and 57 in the heparin group (total continuous renal replacement therapy time: 2383 h). The median circuit lifetime was significantly longer for regional citrate anticoagulation (53.0; interquartile range, 40–70 h) than for heparin anticoagulation (40.25; interquartile range, 22.75–53.5 h; p = 0.025). Mortality rates were similar in both groups (31.58% vs 30.77%). The most common indication for dialysis was hypervolemia in both groups. Transfusion rates were 1.65 units (interquartile range, 0.5–2.38) with heparin and 0.8 units (interquartile range, 0.3–2.0) with citrate (p = 0.32). Clotting-related hemofilter failure occurred in 11.36% of filters in the citrate group compared with 26.31% of filters in the heparin group. Conclusion: Our study showed that citrate is superior in terms of safety and efficacy, with longer filter life span. Regional citrate should be considered as a better anticoagulation method than heparin for continuous renal replacement therapy in critically ill children.

Continuous Renal Replacement Therapy in Critically Ill Children in the Pediatric Intensive Care Unit: A Retrospective Analysis of Real-Life Prescriptions, Complications, and Outcomes

“…In line with previous experiences reported in the literature ( 36 , 37 ), we found that dimension of vascular access and anticoagulation strategy were independent predictors for circuit clotting. In particular, smaller vascular access (≤ 8 Fr) was significantly associated with filter clotting.…”

Regional Citrate Anticoagulation and Systemic Anticoagulation during Pediatric Continuous Renal Replacement Therapy: A Systematic Literature Review

“…Ten of the eleven selected studies report CL or clotting rate as treatment outcomes [ 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ] ( Table 3 ). Eight studies reporting CL as treatment outcomes, and cumulatively counting for 1550 procedures, consistently identify the superiority of RCA over systemic anticoagulation with heparin in prolonging CL.…”

Desialylation of platelet surface glycans enhances platelet adhesion to adsorbent polymers for lipoprotein apheresis

“…The exposure of whole blood to large adsorbent surfaces in therapeutic apheresis requires adsorbent polymers of particularly high blood compatibility to avoid adverse reactions at the blood-adsorbent interface, 26 such as activation of immune cells or platelets. While device-related parameters including the chemical composition, charge, and morphology of adsorbent polymers and the choice of the anticoagulant can influence blood cell activation in the extracorporeal circuit, 18 , 27 , 28 – 30 host-related factors may play a role, as well.…”