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Regional citrate versus systemic heparin anticoagulation for continuous renal replacement therapy in critically ill children.
Int J Artif Organs. 2020 Apr; 43(4):234-241.IJ

Abstract

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.

Authors+Show Affiliations

Department of Pediatric Intensive Care, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey.Department of Pediatric Intensive Care, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey.Department of Pediatric Intensive Care, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey.Department of Pediatric Intensive Care, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31856634

Citation

Sık, Guntulu, et al. "Regional Citrate Versus Systemic Heparin Anticoagulation for Continuous Renal Replacement Therapy in Critically Ill Children." The International Journal of Artificial Organs, vol. 43, no. 4, 2020, pp. 234-241.
Sık G, Demirbuga A, Annayev A, et al. Regional citrate versus systemic heparin anticoagulation for continuous renal replacement therapy in critically ill children. Int J Artif Organs. 2020;43(4):234-241.
Sık, G., Demirbuga, A., Annayev, A., & Citak, A. (2020). Regional citrate versus systemic heparin anticoagulation for continuous renal replacement therapy in critically ill children. The International Journal of Artificial Organs, 43(4), 234-241. https://doi.org/10.1177/0391398819893382
Sık G, et al. Regional Citrate Versus Systemic Heparin Anticoagulation for Continuous Renal Replacement Therapy in Critically Ill Children. Int J Artif Organs. 2020;43(4):234-241. PubMed PMID: 31856634.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Regional citrate versus systemic heparin anticoagulation for continuous renal replacement therapy in critically ill children. AU - Sık,Guntulu, AU - Demirbuga,Asuman, AU - Annayev,Agageldi, AU - Citak,Agop, Y1 - 2019/12/19/ PY - 2019/12/21/pubmed PY - 2019/12/21/medline PY - 2019/12/21/entrez KW - 4% trisodium KW - Regional citrate anticoagulation KW - continuous renal replacement therapies KW - continuous veno-venous hemodialysis KW - heparin anticoagulation SP - 234 EP - 241 JF - The International journal of artificial organs JO - Int J Artif Organs VL - 43 IS - 4 N2 - 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. SN - 1724-6040 UR - https://www.unboundmedicine.com/medline/citation/31856634/Regional_citrate_versus_systemic_heparin_anticoagulation_for_continuous_renal_replacement_therapy_in_critically_ill_children L2 - https://journals.sagepub.com/doi/10.1177/0391398819893382?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -
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