Citrate anticoagulation and systemic heparin anticoagulation during continuous renal replacement therapy among critically-ill children

Abstract

BakcgroundThe aim of this study was to evaluate the efficacy and safety of citrate versus heparin anticoagulation for CRRT in critically-ill children.MethodsThis retrospective comparative cohort reviewed the clinical records of critically-ill children undergoing CRRT with either RCA or systemic heparin anticoagulation. The primary outcome measure was hemofilter survival time. Secondary outcomes included the comparison of complications and metabolic disorders.ResultsA total of 131 patients (55 RCA and 76 systemic heparin) were included, in which a cumulative number of 280 hemofilters were used (115 in RCA with 5762 h total CRRT time, and 165 in systemic heparin with 6230 h total CRRT time). Hemofilter survival was significantly longer for RCA (51.0 h; IQR: 24–67 h) compared to systemic heparin (29.5 h; IQR, 17–48 h) (p = 0.002). Clotting-related hemofilter failure occurred in 9.6% of the RCA group compared to 19.6% in the systemic heparin group (p = 0.038). Citrate accumulation occurred in 4 (3.5%) of 115 RCA sessions. Hypocalcemia and metabolic alkalosis episodes were significantly more frequent in RCA recipients (35.7% vs 15.2%, p < 0.0001; 33.0% vs 19.4%, p = 0.009).ConclusionRCA is a safe and effective anticoagulation method for CRRT in critically-ill children and it prolongs hemofilter survival.ImpactRCA is superior to systemic heparin for the prolongation of circuit survival (overall and for clotting-related loss) during CRRT.These data indicate that RCA can be used to maximize the effective delivery of CRRT in critically-ill patients admitted to the PICU.There are potential cost-saving implications from our results owing to benefits such as less circuit downtime and fewer circuit changes.