Regional Citrate Anticoagulation for Continuous Renal Replacement Therapy ‐ A Safe and Effective Low‐Dose Protocol

Nephrology ◽  
2019 ◽  
Vol 25 (4) ◽  
pp. 305-313 ◽  
Author(s):  
Cheng Boon Poh ◽  
Poh Choo Tan ◽  
Jia Wen Kam ◽  
Chuin Siau ◽  
Noelle L Lim ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Low Dose ◽  
Regional Citrate Anticoagulation ◽  
Citrate Anticoagulation

scholarly journals A cost comparison of regional citrate versus low-dose systemic heparin anticoagulation in continuous renal replacement therapy

2019 ◽  
Vol 47 (3) ◽  
pp. 281-287 ◽  
Author(s):  
Chathuri U Dissanayake ◽  
Chrianna I Bharat ◽  
Brigit L Roberts ◽  
Matthew HR Anstey
Keyword(s):  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Low Dose ◽  
Median Filter ◽  
Regional Citrate Anticoagulation ◽  
Secondary Outcome ◽  
Citrate Anticoagulation ◽  
Filter Life ◽  
Heparin Anticoagulation

We compared the cost of continuous renal replacement therapy (CRRT) in critically ill patients using two different anticoagulation strategies: regional citrate and low-dose systemic heparin in a single-centre, prospective observational study in an adult Australian tertiary intensive care unit (ICU). All patients receiving CRRT between October 2015 and May 2016 were included in the study. Costs were modelled using the number of filter sets, number of dialysis bags, amount of citrate, heparin and calcium replacement required, and cost of monitoring the anticoagulation. The primary outcome was cost associated with CRRT per patient per day. The secondary outcome was efficacy of CRRT. In total, 66 patients were commenced on dialysis that required anticoagulation. Twenty-four patients were commenced on regional citrate anticoagulation and 42 patients commenced on systemic low-dose heparin anticoagulation. Median filter life, though not statistically significant, was longer in the citrate group by 7.7 hours ( P=0.152), however the median cost of anticoagulation was AUD$317.91 higher in the citrate than the heparin group per patient per day ( P=0.0020). While regional citrate anticoagulation may prolong filter life, it is also more expensive than low-dose systemic heparin. Choice of anticoagulation in CRRT should include cost as one of the variables that clinicians consider.

Clinical Impact of Regional Citrate Anticoagulation in Continuous Renal Replacement Therapy in Critically Ill Patients

2017 ◽  
Vol 40 (12) ◽  
pp. 676-682 ◽  
Author(s):  
Maria Huguet ◽  
Lida Rodas ◽  
Miquel Blasco ◽  
Luis F. Quintana ◽  
Jordi Mercadal ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Red Blood Cell Transfusion ◽  
Regional Citrate Anticoagulation ◽  
Transfusion Rate ◽  
Metabolic Disturbances ◽  
Heparin Group ◽  
Metabolic Complications ◽  
Citrate Anticoagulation

Background Regional citrate anticoagulation (RCA) is being used increasingly in continuous renal replacement therapy (CRRT) as a safer alternative to heparin. However, complex metabolic control to avoid side effects have generated discrepancies about its introduction into everyday practice. We aimed to compare both anticoagulation techniques in terms of efficacy, safety and feasibility. Methods Observational retrospective study performed in 3 specialized ICUs in patients receiving CVVHDF with RCA between January 2013 and May 2016. Heparin-treated patients matched by age, sex and disease severity treated in the preceding year were selected as historic controls. Filter lifetime, number of filters used, haemorrhagic complications and metabolic complications were recorded. Results 54 patients (27 treated with RCA and 27 with heparin) were included in the study. Filter lifetimes in the first 72 hours were 55.1 ± 21.8 hours in the RCA group compared to 38.8 ± 24.8 hours in the heparin group, (p = 0.004). In addition, the number of filters used in the first 72 hours was significantly higher in the heparin group (2.4 ± 1.3 vs. 1.5 ± 0.7; p = 0.004). There was a trend toward a lower incidence of bleeding in the RCA group, with a significantly lower red blood cell transfusion rate (p = 0.027) in the citrate group. No clinically significant metabolic disturbances were observed in the RCA group. Regarding outcomes, there were no significant differences between groups. Conclusions These results suggest that the implementation of CVVHDF with RCA using concentrated citrate solutions prolongs filter lifetime, achieves a longer effective hemodiafiltration time and is a safe and feasible method.

scholarly journals Complications of Regional Citrate Anticoagulation for Continuous Renal Replacement Therapy: An Observational Study

2020 ◽  
Vol 49 (5) ◽  
pp. 567-575 ◽  
Author(s):  
Nathan Axel Bianchi ◽  
Marco Altarelli ◽  
Philippe Eckert ◽  
Antoine Guillaume Schneider
Keyword(s):  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Real Life ◽  
Regional Citrate Anticoagulation ◽  
Acid Base ◽  
Metabolic Complications ◽  
Citrate Anticoagulation ◽  
Randomized Controlled ◽  
Heparin Anticoagulation

Introduction: Regional citrate anticoagulation (RCA) is the recommended anticoagulation modality for continuous renal replacement therapy (CRRT). RCA was associated with a low rate of complications in randomized controlled trials. However, little is known about the type and rate of complications in real life. We sought to describe complications associated with RCA in comparison with those associated with heparin anticoagulation. Methods: In our institution, RCA has been the default anticoagulation modality for CRRT in all patients without contraindications since 2013. We have retrospectively reviewed all consecutive patients who received CRRT between January and December 2016 in our institution. For each CRRT session, we have assessed circuit duration, administered dose, as well as therapy-associated complications. Those parameters were compared according to whether the circuit was run in continuous veno-venous hemodialysis (CVVHD) mode with RCA or continuous veno-venous hemofiltration (CVVH) mode with heparin anticoagulation. Results: We analyzed 691 CRRT sessions in 121 patients. Of those 400 (57.9%) were performed in CVVHD-RCA mode and 291 (42.1%) in CVVH-Heparin Mode. Compared with ­CVVH-Heparin mode, CVVHD-RCA mode was associated with a longer circuit lifespan (median duration 54.9 interquartile range [IQR 44.6] vs. 15.3 h [IQR 22.4], p < 0.0001). It was associated with a higher rate of metabolic acidosis 77 (20.2%) vs. 18 (7.2%), (p < 0.0001), alkalosis 186 (48.7%) vs. 43 (17.1%), (p= 0.0001), and hypocalcemia 96 (25.07%) vs. 26 events (10.79%), p < 0.0001. However, the majority of these alterations were of benign or moderate severity. Only one possible citrate intoxication was observed. Conclusions: CVVHD-RCA was associated with a much longer circuit life but an increased rate of minor metabolic complications, in particular acid-base derangements. Some of these complications might have been prevented by therapy adaptation. Medical and nursing staff education is of major importance in the implementation of an RCA protocol.

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

2019 ◽  
Vol 43 (4) ◽  
pp. 234-241 ◽  
Author(s):  
Guntulu Sık ◽  
Asuman Demirbuga ◽  
Agageldi Annayev ◽  
Agop Citak
Keyword(s):  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Interquartile Range ◽  
Critically Ill Children ◽  
Regional Citrate Anticoagulation ◽  
Heparin Group ◽  
Citrate Anticoagulation ◽  
Heparin Anticoagulation

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.

Sign in / Sign up

Export Citation Format

Share Document