Management of regional citrate anticoagulation for continuous renal replacement therapy: guideline recommendations from Chinese emergency medical doctor consensus

Abstract

Continuous renal replacement therapy (CRRT) is widely used for treating critically-ill patients in the emergency department in China. Anticoagulant therapy is needed to prevent clotting in the extracorporeal circulation during CRRT. Regional citrate anticoagulation (RCA) has been shown to potentially be safer and more effective and is now recommended as the preferred anticoagulant method for CRRT. However, there is still a lack of unified standards for RCA management in the world, and there are many problems in using this method in clinical practice. The Emergency Medical Doctor Branch of the Chinese Medical Doctor Association (CMDA) organized a panel of domestic emergency medicine experts and international experts of CRRT to discuss RCA-related issues, including the advantages and disadvantages of RCA in CRRT anticoagulation, the principle of RCA, parameter settings for RCA, monitoring of RCA (mainly metabolic acid–base disorders), and special issues during RCA. Based on the latest available research evidence as well as the paneled experts’ clinical experience, considering the generalizability, suitability, and potential resource utilization, while also balancing clinical advantages and disadvantages, a total of 16 guideline recommendations were formed from the experts’ consensus.

Filter Lifespan, Treatment Effect, and Influencing Factors of Continuous Renal Replacement Therapy for Severe Burn Patients

“…However, it may have the risk of bleeding. 25 In 2018, the cost of 4% sodium citrate was approximately 20 yuan/200 mL. If the common prescription in the department is 1.3 times the initial blood flow rate (150 mL/min), the hourly cost would be around 20 yuan, resulting in a 36-h drug cost of 720 yuan.…”

“…Recent evidence suggests that sodium citrate is potentially a safer and more effective option, leading to its recommendation as the preferred anticoagulation method for CRRT. 25 Among patients with AKI, sodium citrate anticoagulation resulted in a notably extended filter lifespan in comparison to heparin anticoagulation. 26 , 27 Nafamostat mesylate, a synthetic serine protease inhibitor, 28 is often used in CRRT procedures in Japan and South Korea.…”

Research on the development methodology for clinical practice guidelines for organic integration of traditional Chinese and Western medicine

“…When formulating recommendations, considering the generalization, suitability, and potential resource utilization, while also balancing clinical advantages and disadvantages is quite necessary and helps to form rigorous and reasonable recommendations. This view and method have been considered and practiced in many published guidelines [ 19 , 20 ]. Considering those affecting factors for developing guidelines for integrated TCM and WM, especially in the selection of intervention measures between TCM and WM, the generalization of intervention and the values of patients may have obvious differences.…”

Alkalosis in Regional Citrate Anticoagulation during Continuous Renal Replacement Therapy—— A single-center retrospective study

“…Citrate that is not eliminated by the extracorporeal circuit enters the systemic circulation and is metabolized, leading to an excessive alkali load. Theoretically, CRRT metrics, including blood ow rate, citrate ow rate, replacement uid or dialysate ow rate, and e uent rate, in uence the ltration of citrate complexes, further in uencing acid-base balance [20]. This relationship needs to be revised clinically, and current RCA protocols should be improved to reduce the incidence of metabolic alkalosis.…”