A mode of CVVH with regional citrate anticoagulation compared to no anticoagulation for acute kidney injury patients at high risk of bleeding

Abstract

The study was designed to assess a practical mode of postdilution continuous venovenous hemofiltration (CVVH) with regional citrate anticoagulation (RCA) using a calcium-containing replacement solution, and to compare it with a CVVH mode with no anticoagulation (NA). Both methods were employed in our center for acute kidney injury (AKI) patients at high risk of bleeding. Fifty-six patients were equally allocated into the RCA-CVVH group and the NA-CVVH group. The study displayed no significant differences between groups involving baseline characteristics, severity level, blood gas analysis, hepatic/renal/coagulative functions, electrolytes, hemoglobin concentration, and platelet counts before or after continuous renal replacement therapy (CRRT). Compared to the NA-CVVH group, the RCA-CVVH group had a lower level of transfused packed red blood cells and platelet as well as a longer filter lifespan. The result showed no substantial differences between groups in terms of the mean supporting time and cost involving CRRT per person, the length of ICU and hospital stays, and the ICU survival. Homeostasis was basically preserved at a target range during the RCA post-CVVH procedure. Serious complications did not arise during the RCA process. RCA postdilutional CVVH is a safe and effective mode for application in AKI patients with a high risk of bleeding, and it can extend the filter lifespan and decrease blood loss, compared with the NA mode for CRRT. Further studies are needed to evaluate this mode for CRRT. (Retrospective Registration number ChiCTR1800016462, Registration date 2/6/2018)

Regional citrate versus systemic heparin anticoagulation for continuous renal replacement therapy in critically ill children

“…The blood gas analysis and blood electrolytes (including tCa and iCa) must be closely monitored if the citrate is used as anticoagulant. 23,24 In contrast to popular belief, studies that do not observe side effects of citrate have been published more frequently. Citrate anticoagulation compared to no anticoagulation for acute kidney injury patients, and there were no significant differences in blood pH, the blood levels of bicarbonate, BE, creatinine, blood urea nitrogen, sodium, magnesium, and calcium between the two groups before or after CRRT.…”

Continuous renal replacement therapy in elderly with acute kidney injury

“…In an open RCT that compared RCA to no anticoagulation, most of the patients were elderly and were admitted to the ICU after surgery [30]. There were no differences between the groups in terms of supporting time, cost, length of ICU and hospital stay, and ICU survival rate.…”

Comparison of different anticoagulation strategies for renal replacement therapy in critically ill patients with COVID-19: a cohort study

“…Administration of citrate significantly improved mean treatment duration of CVVHD for COVID-19 patients. Regional anticoagulation with citrate is a suitable alternative to UFH in critically ill patients during CVVHD [ 27 , 28 ]. In contrast to systemic anticoagulation, citrate complexes calcium.…”