Citrate versus heparin anticoagulation for continuous renal replacement therapy: an updated meta-analysis of RCTs

Bai, Ming; Zhou, Mi; He, Lijie; Ma, Feng; Li, Yangping; Yu, Yan; Wang, Pengbo; Li, Li; Jiang, Rui; Zhao, Lijuan; Sun, Shan

doi:10.1007/s00134-015-4099-0

Cited by 172 publications

(134 citation statements)

References 38 publications

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“…Recent evidence has confirmed the superiority of regional citrate compared with systemic heparin anticoagulation both to maintain patency of the extracorporeal circuit and to reduce bleeding complications [3,4,5,6]. Despite this weight of favorable evidence, the uptake of RCA has been limited in many countries, including in the UK [7].…”

Section: Introductionmentioning

confidence: 99%

Implementation of a Simplified Regional Citrate Anticoagulation Protocol for Post-Dilution Continuous Hemofiltration Using a Bicarbonate Buffered, Calcium Containing Replacement Solution

et al. 2016

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Background/Aims: Recent updates to the Nikkiso Aquarius continuous renal replacement therapy (CRRT) platform allowed us to develop a post-dilution protocol for regional citrate anticoagulation (RCA) using standard bicarbonate buffered, calcium containing replacement solution with acid citrate dextrose formula-A as a citrate source. Our objective was to demonstrate that the protocol was safe and effective. Methods: Prospective audit of consecutive patients receiving RCA for CRRT within intensive care unit, who were either contraindicated to heparin or had poor filter lifespan (<12 h for 2 consecutive filters) on heparin. Results: We present the first 29 patients who used 98 filters. After excluding ‘non-clot' filter loss, 50% had a duration of >27 h. Calcium supplementation was required for 30 (30%) filter circuits, in 17 of 29 (58%) patients. One patient discontinued the treatment due to metabolic alkalosis, but there were no adverse bleeding events. Conclusion: Post-dilution RCA system is effective and simple to use on the Aquarius platform and results in comparable filter life for patients relatively contraindicated to heparin.

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Section: Introductionmentioning

confidence: 99%

Implementation of a Simplified Regional Citrate Anticoagulation Protocol for Post-Dilution Continuous Hemofiltration Using a Bicarbonate Buffered, Calcium Containing Replacement Solution

et al. 2016

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“…It is well tolerated and has been shown to reduce bleeding risk and improve circuit life compared with traditional systemic heparin anticoagulation (14,21). Citrate, which exerts its anticoagulant effect by chelating calcium, is subsequently removed either through the dialysis filter or via rapid metabolism in various tissues, predominantly the liver (22).…”

Section: Discussionmentioning

confidence: 99%

Continuous renal replacement therapy: a potential source of calories in the critically ill,

New¹,

Nystrom²,

Frazee³

et al. 2017

The American Journal of Clinical Nutrition

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Background: Overfeeding can lead to multiple metabolic and clinical complications and has been associated with increased mortality in the critically ill. Continuous venovenous hemofiltration (CVVH) represents a potential source of calories that is poorly recognized and may contribute to overfeeding complications. Objective: We aimed to quantify the systemic caloric contribution of acid-citrate-dextrose regional anticoagulation and dextrosecontaining replacement fluids in the CVVH circuit. Design: This was a prospective study in 10 critically ill adult patients who received CVVH from April 2014 to June 2014. Serial pre-and postfilter blood samples (n = 4 each) were drawn and analyzed for glucose and citrate concentrations on each of 2 consecutive days. Results: Participants included 5 men and 5 women with a mean 6 SEM age of 61 6 4 y (range: 42-84 y) and body mass index (in kg/m 2 ) of 28 6 2 (range: 18.3-36.2). There was generally good agreement between data on the 2 study days (CV: 7-11%). Mean 6 SEM pre-and postfilter venous plasma glucose concentrations in the aggregate group were 152 6 10 and 178 6 9 mg/dL, respectively. Net glucose uptake from the CVVH circuit was 54 6 5 mg/min and provided 295 6 28 kcal/d. Prefilter plasma glucose concentrations were higher in patients with diabetes (n = 5) than in those without diabetes (168 6 12 compared with 140 6 14 mg/dL; P , 0.05); however, net glucose uptake was similar (46 6 8 compared with 61 6 6 mg/min; P = 0.15). Mean 6 SEM pre-and postfilter venous plasma citrate concentrations were 1 6 0.1 and 3.1 6 0.2 mmol/L, respectively. Net citrate uptake from the CVVH circuit was 60 6 2 mg/min and provided 218 6 8 kcal/d. Conclusions: During CVVH there was a substantial net uptake of both glucose and citrate that delivered exogenous energy and provided w512 kcal/d. Failure to account for this source of calories in critically ill patients receiving nutrition on CVVH may result in overfeeding.

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“…Among these improvements, the use of double lumen catheters (eliminating the need for an arterial access), the implementation of volumetric pumps into the RRT device, and the overall precision of weighing scales may be recognized as major steps. More recently, the implementation of citrate anticoagulation [2][3][4] protocols [5][6][7] built in to RRT devices has increased filter life and made therapy delivery safer and more reliable [8][9][10] . However, several challenges remain to optimize RRT in critical illness [11] .…”

Section: Introductionmentioning

confidence: 99%

A First Evaluation of OMNI®, A New Device for Continuous Renal Replacement Therapy

et al. 2016

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Background: Omni® (B. Braun, Germany) is a new-generation, continuous renal replacement therapy (CRRT) machine designed to improve user interface, minimize downtime and optimize renal dose delivery. It was never tested in humans. Methods: We used Omni® to provide CRRT in 10 critically ill patients. We collected therapy data, metabolic parameters and evaluated user's satisfaction with a survey. Results: CRRT was delivered using Omni® in CVVH-heparin (6 patients) and CVVHD-citrate (4 patients) modes for a total duration of 617.7 h. No adverse event was observed. The mean filter life was 22.8 (CVVH-heparin) and 33.5 (CVVHD-citrate) h. Alarms-related downtime corresponded to 5.9% of total therapy time. Delivered renal dose was 96.6% of prescribed. Satisfactory metabolic control and fluid removal were achieved. Overall, users evaluated interface, design and usability as excellent. Conclusion: CRRT in CVVH-heparin and CVVHD-citrate modes was provided using Omni® in a safe and efficient way for 10 critically ill patients. Video Journal Club ‘Cappuccino with Claudio Ronco' at http://www.karger.com/?doi=451053.

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Citrate versus heparin anticoagulation for continuous renal replacement therapy: an updated meta-analysis of RCTs

Abstract: Given the lower risk of circuit loss, filter failure, bleeding, and HIT, regional citrate should be considered a better anticoagulation method than heparin for CRRT in critically ill patients without any contraindication.

Cited by 172 publications

References 38 publications

Implementation of a Simplified Regional Citrate Anticoagulation Protocol for Post-Dilution Continuous Hemofiltration Using a Bicarbonate Buffered, Calcium Containing Replacement Solution

Implementation of a Simplified Regional Citrate Anticoagulation Protocol for Post-Dilution Continuous Hemofiltration Using a Bicarbonate Buffered, Calcium Containing Replacement Solution

Continuous renal replacement therapy: a potential source of calories in the critically ill,

A First Evaluation of OMNI®, A New Device for Continuous Renal Replacement Therapy

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