The Safety and Efficacy of Regional Citrate Anticoagulation in Albumin-Assisted Liver Dialysis for Extracorporeal Liver Support in Pediatric Patients

Lion, R; Pekkucuksen, Naile Tufan; Srivaths, Poyyapakkam; Desai, Moreshwar S.; Akcan-Arikan, Ayse

doi:10.1159/000492661

Cited by 8 publications

(5 citation statements)

References 30 publications

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“…RCA was found to be an effective and safe method of anticoagulation during albumin dialysis 21 . A commercial citrate solution, used (anticoagulation citrate dextrose solution‐A) for RCA, can also provide safe and effective anticoagulation for pediatric patients with liver failure during albumin‐assisted dialysis 22 . A recent study found that the cTPEc is safe and well‐tolerated, and it improves coagulation profile and liver function tests in critically ill liver disease patients, but the overall survival remains low (69%, 31/45) 23 .…”

Section: Discussionmentioning

confidence: 99%

A single center retrospective study: Comparison between centrifugal separation plasma exchange with ACD‐A and membrane separation plasma exchange with heparin on acute liver failure and acute on chronic liver failure

Zhu,

Li,

Liu

et al. 2023

J of Clinical Apheresis

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The purpose of this retrospective study is to compare the efficacy and safety of the centrifugal separation therapeutic plasma exchange (TPE) using citrate anticoagulant (cTPEc) with membrane separation TPE using heparin anticoagulant (mTPEh) in liver failure patients. The patients treated by cTPEc were defined as cTPEc group and those treated by mTPEh were defined as mTPEh group, respectively. Clinical characteristics were compared between the two groups. Survival analyses of two groups and subgroups classified by the model for end‐stage liver disease (MELD) score were performed by Kaplan–Meier method and were compared by the log‐rank test. In this study, there were 51 patients in cTPEc group and 18 patients in mTPEh group, respectively. The overall 28‐day survival rate was 76% (39/51) in cTPEc group and 61% (11/18) in mTPEh group (P > .05). The 90‐day survival rate was 69% (35/51) in cTPEc group and 50% (9/18) in mTPEh group (P > .05). MELD score = 30 was the best cut‐off value to predict the prognosis of patients with liver failure treated with TPE, in mTPEh group as well as cTPEc group. The median of total calcium/ionized calcium ratio (2.84, range from 2.20 to 3.71) after cTPEc was significantly higher than the ratio (1.97, range from 1.73 to 3.19) before cTPEc (P < .001). However, there was no significant difference between the mean concentrations of total calcium before cTPEc and at 48 h after cTPEc. Our study concludes that there was no statistically significant difference in survival rate and complications between cTPEc and mTPEh groups. The liver failure patients tolerated cTPEc treatment via peripheral vascular access with the prognosis similar to mTPEh. The prognosis in patients with MELD score < 30 was better than in patients with MELD score ≥ 30 in both groups. In this study, the patients with acute liver failure (ALF) and acute on chronic liver failure (ACLF) treated with cTPEc tolerated the TPE frequency of every other day without significant clinical adverse event of hypocalcemia with similar outcomes to the mTPEh treatment. For liver failure patients treated with cTPEc, close clinical observation and monitoring ionized calcium are necessary to ensure the patients' safety.

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Section: Discussionmentioning

confidence: 99%

A single center retrospective study: Comparison between centrifugal separation plasma exchange with ACD‐A and membrane separation plasma exchange with heparin on acute liver failure and acute on chronic liver failure

Zhu,

Li,

Liu

et al. 2023

J of Clinical Apheresis

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“…Another study found that the probability of lter survival in the RCA group was 94% and in the heparin group 82% during Molecular Adsorbent Recirculating System therapy (P = 0.204) [12]. RCA provides safe and effective anticoagulation for pediatric liver failure patients requiring extracorporeal liver support with albumin-assisted dialysis [13].…”

Section: Discussionmentioning

confidence: 99%

The efficacy and safety of regional citrate anticoagulation centrifugal plasma exchange is equivalent to those of systemic heparin anticoagulation membrane plasma exchange in patients with liver failure: a single center retrospective cohort study

Zhu

Liu

et al. 2022

Preprint

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Background: The purpose of this study is to compare with the efficacy and safety of regional citrate anticoagulation centrifugal plasma exchange and systemic heparin anticoagulation membrane plasma exchange in patients with liver failure.Methods: This study was a single center and retrospective study. All enrolled liver failure patients were treated with therapeutic plasma exchange. The patients treated by regional citrate anticoagulation centrifugal plasma exchange were defined as RCA group and those treated by systemic heparin anticoagulation membrane plasma exchange were defined as heparin group, respectively. Survival and clinical characteristics, including patients’ age, gender, total bilirubin, serum creatinine, international normalized ratio, platelet count, types of liver failure, arterial blood gas analysis, the model for end-stage liver disease (MELD) score, and occurrence of complications were compared between the two groups. Survival analyses of two groups and subgroups classified by MELD score were performed by Kaplan-Meier method and were compared by the log-rank test.Results: There were 69 patients enrolled in this study, 51 patients in RCA group and 18 patients in heparin group respectively. In overall patients, the 28-day mortality rate was 41% in RCA group and 39% in heparin group (P > 0.05). The 90-day mortality rate was 59% in RCA group and 50% in heparin group (P > 0.05). MELD best-fit value is 30, and area under the ROC curve is 0.7208 in the transplantation free patients with liver failure in both RCA group and heparin group. There was no significant difference in the occurrence of complications between the two groups.Conclusions: In conclusion, our study demonstrates that the efficacy and safety of regional citrate anticoagulation centrifugal plasma exchange is equivalent to those of systemic heparin anticoagulation membrane plasma exchange in patients with liver failure. RCA plasma exchange at an interval of 48 hours in patients with acute or acute-on-chronic liver failure may be an effective in reducing the occurrence of the complication of citrate accumulation. RCA centrifugal plasma exchange treatment can achieve a good prognosis and well tolerance, especially in MELD<30 patients with liver failure.

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“…A meta-analysis that included 10 observational studies of 1241 patients with hepatic dysfunction undergoing RCA-CRRT showed no significant difference in plasma citrate levels in patients compared to those without hepatic dysfunction [ 60 ]. Several studies have shown that RCA can also be used safely in patients with renal failure after liver transplantation or in patients being treated with extracorporeal artificial liver support [ 61 – 63 ].…”

Section: Methodsmentioning

confidence: 99%

Management of regional citrate anticoagulation for continuous renal replacement therapy: guideline recommendations from Chinese emergency medical doctor consensus

Liu¹,

Xu²,

Liu³

et al. 2023

Military Med Res

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Continuous renal replacement therapy (CRRT) is widely used for treating critically-ill patients in the emergency department in China. Anticoagulant therapy is needed to prevent clotting in the extracorporeal circulation during CRRT. Regional citrate anticoagulation (RCA) has been shown to potentially be safer and more effective and is now recommended as the preferred anticoagulant method for CRRT. However, there is still a lack of unified standards for RCA management in the world, and there are many problems in using this method in clinical practice. The Emergency Medical Doctor Branch of the Chinese Medical Doctor Association (CMDA) organized a panel of domestic emergency medicine experts and international experts of CRRT to discuss RCA-related issues, including the advantages and disadvantages of RCA in CRRT anticoagulation, the principle of RCA, parameter settings for RCA, monitoring of RCA (mainly metabolic acid–base disorders), and special issues during RCA. Based on the latest available research evidence as well as the paneled experts’ clinical experience, considering the generalizability, suitability, and potential resource utilization, while also balancing clinical advantages and disadvantages, a total of 16 guideline recommendations were formed from the experts’ consensus.

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The Safety and Efficacy of Regional Citrate Anticoagulation in Albumin-Assisted Liver Dialysis for Extracorporeal Liver Support in Pediatric Patients

Cited by 8 publications

References 30 publications

A single center retrospective study: Comparison between centrifugal separation plasma exchange with ACD‐A and membrane separation plasma exchange with heparin on acute liver failure and acute on chronic liver failure

A single center retrospective study: Comparison between centrifugal separation plasma exchange with ACD‐A and membrane separation plasma exchange with heparin on acute liver failure and acute on chronic liver failure

The efficacy and safety of regional citrate anticoagulation centrifugal plasma exchange is equivalent to those of systemic heparin anticoagulation membrane plasma exchange in patients with liver failure: a single center retrospective cohort study

Management of regional citrate anticoagulation for continuous renal replacement therapy: guideline recommendations from Chinese emergency medical doctor consensus

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