scholarly journals Regional citrate anticoagulation for intermittent hemodialysis in the intensive care: what is the optimal setup?

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jakob Gubensek ◽  
Vanja Persic
Keyword(s):  
Intensive Care ◽  
Regional Citrate Anticoagulation ◽  
Intermittent Hemodialysis ◽  
Citrate Anticoagulation

scholarly journals Citrate versus non-citrate anticoagulation in continuous renal replacement therapy: Results following a change in local critical care protocol

2016 ◽  
Vol 18 (1) ◽  
pp. 47-51
Author(s):  
Samina R Chowdhury ◽  
Tom Lawton ◽  
Aaqid Akram ◽  
Robert Collin ◽  
James Beck
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Regional Citrate Anticoagulation ◽  
Nursing Workload ◽  
Citrate Anticoagulation ◽  
Care Protocol ◽  
Transfusion Requirements

Continuous renal replacement therapy necessitates the use of anticoagulation. The anticoagulant of choice has traditionally been heparin. Emerging evidence has highlighted the deleterious effects of systemic heparin anticoagulation in the critically ill. Regional citrate anticoagulation has been used as an alternative in the setting of continuous renal replacement therapy. Our retrospective before-and-after cohort study aimed to ascertain if regional citrate anticoagulation is associated with any benefit in terms of circuit longevity, rates of complications, blood transfusion requirements and mortality, when introduced to a large general intensive care unit with a case mix of acute medical patients and acute and elective surgical patients. The switch to regional citrate anticoagulation for continuous renal replacement therapy in our intensive care unit has been associated with a dramatically longer circuit life, with major implications for cost savings in terms of reduced nursing workload. We hope to look at fiscal aspects of the change in protocol in greater depth.

A simple and novel technique for regional citrate anticoagulation during intermittent hemodialysis may obviate the need for calcium monitoring

2017 ◽  
Vol 43 (12) ◽  
pp. 1927-1928 ◽  
Author(s):  
Thomas Robert ◽  
Come Bureau ◽  
Ludivine Lebourg ◽  
Eric Rondeau ◽  
Thierry Petitclerc ◽  
...  
Keyword(s):  
Regional Citrate Anticoagulation ◽  
Intermittent Hemodialysis ◽  
Citrate Anticoagulation ◽  
Novel Technique

scholarly journals Comparison between regional citrate anticoagulation and heparin for intermittent hemodialysis in ICU patients: a propensity score-matched cohort study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Christophe Leroy ◽  
Bruno Pereira ◽  
Edouard Soum ◽  
Claire Bachelier ◽  
Elisabeth Coupez ◽  
...  
Keyword(s):  
Propensity Score ◽  
Regional Citrate Anticoagulation ◽  
Intermittent Hemodialysis ◽  
Efficacy And Safety ◽  
Icu Patients ◽  
Citrate Anticoagulation ◽  
Increased Risk ◽  
Heparin Anticoagulation ◽  
Calcium Infusion

Abstract Background Regional citrate anticoagulation (RCA) is the gold standard of anticoagulation for continuous renal replacement therapy but is rarely used for intermittent hemodialysis (IHD) in ICU. Few studies assessed the safety and efficacy of RCA during IHD in ICU; however, no data are available comparing RCA to heparin anticoagulation, which are commonly used for IHD. The aim of this study was to assess the efficacy and safety of RCA compared to heparin anticoagulation during IHD. Methods This retrospective single-center cohort study included consecutive ICU patients treated with either heparin anticoagulation (unfractionated or low-molecular-weight heparin) or RCA for IHD from July to September in 2015 and 2017. RCA was performed with citrate infusion according to blood flow and calcium infusion by diffusive influx from dialysate. Using a propensity score analysis, as the primary endpoint we assessed whether RCA improved efficacy, quantified with Kt/V from the ionic dialysance, compared to heparin anticoagulation. The secondary endpoint was safety. Exploratory analyses were performed on the changes in efficacy and safety between the implementation period (2015) and at long term (2017). Results In total, 208 IHD sessions were performed in 56 patients and were compared (124 RCA and 84 heparin coagulation). There was no difference in Kt/V between RCA and heparin (0.95 ± 0.38 vs. 0.89 ± 0.32; p = 0.98). A higher number of circuit clotting (12.9% vs. 2.4%; p = 0.02) and premature interruption resulting from acute high transmembrane pressure (21% vs. 7%; p = 0.02) occurred in the RCA sessions compared to the heparin sessions. In the propensity score-matching analysis, RCA was associated with an increased risk of circuit clotting (absolute differences = 0.10, 95% CI [0.03–0.18]; p = 0.008). There was no difference in efficacy and safety between the two time periods (2015 and 2017). Conclusion RCA with calcium infusion by diffusive influx from dialysate for IHD was easy to implement with stable long-term efficacy and safety but did not improve efficacy and could be associated with an increased risk of circuit clotting compared to heparin anticoagulation in non-selected ICU patients. Randomized trials to determine the best anticoagulation for IHD in ICU patients should be conducted in a variety of settings.

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