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Multi-centre evaluation of anticoagulation in patients receiving continuous renal replacement therapy (CRRT).
Nephrol Dial Transplant. 2005 Jul; 20(7):1416-21.ND

Abstract

BACKGROUND

Heparin (hepACG) and regional citrate anticoagulation (citACG) remain the most commonly reported continuous renal replacement therapy (CRRT) ACG methods employed. No prospective multi-centre published data exist that compare different ACG methods with respect to CRRT filter life span or patient complications.

METHODS

A total of 138 patients from seven US centres receiving 18 208 h of CRRT comprising a total of 442 CRRT circuits were utilized to assess filter life span and ACG-related complications in patients receiving CRRT with hepACG, citACG or no ACG (noACG).

RESULTS

Mean circuit life was 41.2+/-30.8 h. Mean circuit survival was no different for circuits receiving hepACG (42.1+/-27.1 h) and citACG (44.7+/-35.9 h), but was significantly lower for circuits with noACG (27.2+/-21.5 h, P<0.005). Kaplan-Meier analyses revealed no survival difference between hepACG and citACG circuits, but significantly lower survival for noACG circuits (P<0.001). Log-rank analysis showed that 69% of hepACG and citACG circuits whereas only 28% of noACG were functional at 60 h. Clotting rates were similar for hepACG circuits (58 out of 230, 25%) and citACG circuits (43 out of 158, 27%), but were significantly higher for noACG circuits (27 out of 54, 50%, P < 0.001). Life-threatening bleeding complications attributable to ACG were noted in the hepACG group but were absent in the citACG group.

CONCLUSIONS

The current analysis represents the largest evaluation of CRRT ACG methods to date. While the standard hepACG and citACG methods studied in the prospective paediatric CRRT registry led to similar filter life spans and were superior to noACG, our data suggest that citACG may result in less life-threatening complications.

Authors+Show Affiliations

Brophy PD
C. S. Mott Children's Hospital, University of Michigan, F6865-0297, 1505 Simpson Rd E, Ann Arbor, MI 48109, USA. pbrophy@umich.edu
Somers MJ
No affiliation info available
Baum MA
No affiliation info available
Symons JM
No affiliation info available
McAfee N
No affiliation info available
Fortenberry JD
No affiliation info available
Rogers K
No affiliation info available
Barnett J
No affiliation info available
Blowey D
No affiliation info available
Baker C
No affiliation info available
Bunchman TE
No affiliation info available
Goldstein SL
No affiliation info available

MeSH

AdolescentAdultAnticoagulantsChildChild, PreschoolCitric AcidFollow-Up StudiesGraft Occlusion, VascularHemorrhageHeparinHumansInfantInfant, NewbornKidney DiseasesMembranes, ArtificialProspective StudiesRenal Replacement TherapyTreatment Outcome

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15855212

Clinical Trial Links

Simplified Regional Citrate Anticoagulation Protocols for CVVH, CVVHDF and SLED: a Pilot Study

Citation

Brophy, Patrick D., et al. "Multi-centre Evaluation of Anticoagulation in Patients Receiving Continuous Renal Replacement Therapy (CRRT)." Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, vol. 20, no. 7, 2005, pp. 1416-21.
Brophy PD, Somers MJ, Baum MA, et al. Multi-centre evaluation of anticoagulation in patients receiving continuous renal replacement therapy (CRRT). Nephrol Dial Transplant. 2005;20(7):1416-21.
Brophy, P. D., Somers, M. J., Baum, M. A., Symons, J. M., McAfee, N., Fortenberry, J. D., Rogers, K., Barnett, J., Blowey, D., Baker, C., Bunchman, T. E., & Goldstein, S. L. (2005). Multi-centre evaluation of anticoagulation in patients receiving continuous renal replacement therapy (CRRT). Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, 20(7), 1416-21.
Brophy PD, et al. Multi-centre Evaluation of Anticoagulation in Patients Receiving Continuous Renal Replacement Therapy (CRRT). Nephrol Dial Transplant. 2005;20(7):1416-21. PubMed PMID: 15855212.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Multi-centre evaluation of anticoagulation in patients receiving continuous renal replacement therapy (CRRT). AU - Brophy,Patrick D, AU - Somers,Michael J G, AU - Baum,Michelle A, AU - Symons,Jordan M, AU - McAfee,Nancy, AU - Fortenberry,James D, AU - Rogers,Kristine, AU - Barnett,Joni, AU - Blowey,Douglas, AU - Baker,Cheryl, AU - Bunchman,Timothy E, AU - Goldstein,Stuart L, Y1 - 2005/04/26/ PY - 2005/4/28/pubmed PY - 2005/10/7/medline PY - 2005/4/28/entrez SP - 1416 EP - 21 JF - Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association JO - Nephrol Dial Transplant VL - 20 IS - 7 N2 - BACKGROUND: Heparin (hepACG) and regional citrate anticoagulation (citACG) remain the most commonly reported continuous renal replacement therapy (CRRT) ACG methods employed. No prospective multi-centre published data exist that compare different ACG methods with respect to CRRT filter life span or patient complications. METHODS: A total of 138 patients from seven US centres receiving 18 208 h of CRRT comprising a total of 442 CRRT circuits were utilized to assess filter life span and ACG-related complications in patients receiving CRRT with hepACG, citACG or no ACG (noACG). RESULTS: Mean circuit life was 41.2+/-30.8 h. Mean circuit survival was no different for circuits receiving hepACG (42.1+/-27.1 h) and citACG (44.7+/-35.9 h), but was significantly lower for circuits with noACG (27.2+/-21.5 h, P<0.005). Kaplan-Meier analyses revealed no survival difference between hepACG and citACG circuits, but significantly lower survival for noACG circuits (P<0.001). Log-rank analysis showed that 69% of hepACG and citACG circuits whereas only 28% of noACG were functional at 60 h. Clotting rates were similar for hepACG circuits (58 out of 230, 25%) and citACG circuits (43 out of 158, 27%), but were significantly higher for noACG circuits (27 out of 54, 50%, P < 0.001). Life-threatening bleeding complications attributable to ACG were noted in the hepACG group but were absent in the citACG group. CONCLUSIONS: The current analysis represents the largest evaluation of CRRT ACG methods to date. While the standard hepACG and citACG methods studied in the prospective paediatric CRRT registry led to similar filter life spans and were superior to noACG, our data suggest that citACG may result in less life-threatening complications. SN - 0931-0509 UR - https://www.unboundmedicine.com/medline/citation/15855212/Multi_centre_evaluation_of_anticoagulation_in_patients_receiving_continuous_renal_replacement_therapy__CRRT__ DB - PRIME DP - Unbound Medicine ER -