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Is regional citrate superior to systemic heparin anticoagulation for continuous renal replacement therapy? A prospective observational study in an adult regional critical care system.
J Crit Care. 2005 Jun; 20(2):155-61.JC

Abstract

PURPOSE

Continuous renal replacement therapy (CRRT) is commonly used in the care of critically ill patients although the optimal means of anticoagulation is not well defined. We report our regional CRRT protocol that was developed using the principles of quality improvement and compare the effect of regional citrate with systemic heparin anticoagulation on filter life span.

MATERIALS AND METHODS

Prospective observational cohort study in a Canadian adult regional critical care system. A standardized protocol for CRRT has been implemented at all adult intensive care units in the Calgary Health Region since August 1999. All patients with acute renal failure treated with CRRT during October 1, 2002, to September 30, 2003, were identified and followed up prospectively until hospital discharge or death.

RESULTS

Eighty-seven patients with acute renal failure requiring CRRT were identified, 54 were initially treated with citrate, 29 with heparin, and 4 with saline flushes. Citrate and heparin were used in 212 (66%) and 97 (30%) of filters for 8776 and 2651 hours of CRRT, respectively. Overall median (interquartile range) filter life span with citrate was significantly greater than heparin (40 [14-72] vs 20 [5-44] hours, P < .001). The median time to spontaneous filter failure was significantly greater with citrate compared with heparin (>72 vs 33 hours, P < .001). Citrate anticoagulation resulted in greater completion of scheduled filter life span (59% vs 10%, P > .001). Citrate anticoagulation was well tolerated with no patient requiring elective discontinuation for hypernatremia, metabolic alkalosis, or hypocalcemia.

CONCLUSIONS

Regional citrate anticoagulation was associated with prolonged filter survival and increased completion of scheduled filter life span compared with heparin. These data support small studies suggesting that citrate is a superior anticoagulant for CRRT and suggest the need for a future definitive randomized controlled trial.

Authors+Show Affiliations

Bagshaw SM
Department of Critical Care Medicine, University of Calgary and Calgary Health Region, Foothills Medical Centre, Alberta, Canada.
Laupland KB
No affiliation info available
Boiteau PJ
No affiliation info available
Godinez-Luna T
No affiliation info available

MeSH

Acute Kidney InjuryAgedAnticoagulantsCanadaCitratesContraindicationsCritical CareFemaleHeparinHumansMaleMiddle AgedProspective StudiesRenal Replacement TherapySodium Chloride

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16139156

Clinical Trial Links

Study Using Citrate to Replace Heparin in Babies Requiring Extracorporeal Membrane Oxygenation (ECMO)

Citation

Bagshaw, Sean M., et al. "Is Regional Citrate Superior to Systemic Heparin Anticoagulation for Continuous Renal Replacement Therapy? a Prospective Observational Study in an Adult Regional Critical Care System." Journal of Critical Care, vol. 20, no. 2, 2005, pp. 155-61.
Bagshaw SM, Laupland KB, Boiteau PJ, et al. Is regional citrate superior to systemic heparin anticoagulation for continuous renal replacement therapy? A prospective observational study in an adult regional critical care system. J Crit Care. 2005;20(2):155-61.
Bagshaw, S. M., Laupland, K. B., Boiteau, P. J., & Godinez-Luna, T. (2005). Is regional citrate superior to systemic heparin anticoagulation for continuous renal replacement therapy? A prospective observational study in an adult regional critical care system. Journal of Critical Care, 20(2), 155-61.
Bagshaw SM, et al. Is Regional Citrate Superior to Systemic Heparin Anticoagulation for Continuous Renal Replacement Therapy? a Prospective Observational Study in an Adult Regional Critical Care System. J Crit Care. 2005;20(2):155-61. PubMed PMID: 16139156.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Is regional citrate superior to systemic heparin anticoagulation for continuous renal replacement therapy? A prospective observational study in an adult regional critical care system. AU - Bagshaw,Sean M, AU - Laupland,Kevin B, AU - Boiteau,Paul J E, AU - Godinez-Luna,Tomas, PY - 2004/08/16/received PY - 2004/11/07/revised PY - 2005/01/11/accepted PY - 2005/9/6/pubmed PY - 2005/12/16/medline PY - 2005/9/6/entrez SP - 155 EP - 61 JF - Journal of critical care JO - J Crit Care VL - 20 IS - 2 N2 - PURPOSE: Continuous renal replacement therapy (CRRT) is commonly used in the care of critically ill patients although the optimal means of anticoagulation is not well defined. We report our regional CRRT protocol that was developed using the principles of quality improvement and compare the effect of regional citrate with systemic heparin anticoagulation on filter life span. MATERIALS AND METHODS: Prospective observational cohort study in a Canadian adult regional critical care system. A standardized protocol for CRRT has been implemented at all adult intensive care units in the Calgary Health Region since August 1999. All patients with acute renal failure treated with CRRT during October 1, 2002, to September 30, 2003, were identified and followed up prospectively until hospital discharge or death. RESULTS: Eighty-seven patients with acute renal failure requiring CRRT were identified, 54 were initially treated with citrate, 29 with heparin, and 4 with saline flushes. Citrate and heparin were used in 212 (66%) and 97 (30%) of filters for 8776 and 2651 hours of CRRT, respectively. Overall median (interquartile range) filter life span with citrate was significantly greater than heparin (40 [14-72] vs 20 [5-44] hours, P < .001). The median time to spontaneous filter failure was significantly greater with citrate compared with heparin (>72 vs 33 hours, P < .001). Citrate anticoagulation resulted in greater completion of scheduled filter life span (59% vs 10%, P > .001). Citrate anticoagulation was well tolerated with no patient requiring elective discontinuation for hypernatremia, metabolic alkalosis, or hypocalcemia. CONCLUSIONS: Regional citrate anticoagulation was associated with prolonged filter survival and increased completion of scheduled filter life span compared with heparin. These data support small studies suggesting that citrate is a superior anticoagulant for CRRT and suggest the need for a future definitive randomized controlled trial. SN - 0883-9441 UR - https://www.unboundmedicine.com/medline/citation/16139156/Is_regional_citrate_superior_to_systemic_heparin_anticoagulation_for_continuous_renal_replacement_therapy_A_prospective_observational_study_in_an_adult_regional_critical_care_system_ DB - PRIME DP - Unbound Medicine ER -