Advances in continuous renal replacement therapy: citrate anticoagulation update.
Ashita Tolwani1, Keith M Wille
1University of Alabama at Birmingham, Birmingham, AL 35294-0007, USA. atolwani@uab.edu
Blood Purification
|October 26, 2012
Summary
Regional citrate anticoagulation (RCA) offers a safer alternative to heparin for continuous renal replacement therapy (CRRT), reducing bleeding and improving filter survival. Careful monitoring is essential to manage potential complications.
Area of Science:
- Nephrology
- Critical Care Medicine
Background:
- Heparin use in continuous renal replacement therapy (CRRT) is associated with potential side effects.
- Regional citrate anticoagulation (RCA) is emerging as a safer alternative, with simplified protocols enhancing its acceptance.
Purpose of the Study:
- To summarize the characteristics of citrate as an anticoagulant.
- To provide an update on the use of RCA in CRRT.
Main Methods:
- Review of literature on citrate anticoagulation protocols for CRRT.
- Comparison of RCA with unfractionated heparin in terms of efficacy and safety.
Main Results:
- RCA avoids systemic anticoagulation and heparin-induced thrombocytopenia.
- Studies indicate better filter survival times and reduced bleeding with RCA compared to heparin.
- Potential complications like hypernatremia and hypocalcemia require frequent monitoring.
Conclusions:
- RCA is a viable and increasingly accepted anticoagulation method for CRRT.
- Proper monitoring can mitigate the risks associated with citrate use.
- RCA offers significant advantages over heparin in CRRT, including improved outcomes and safety.
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