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Citrate anticoagulation for continuous renal replacement therapy in small children

Jolanta Soltysiak1, Alfred Warzywoda, Bartłomiej Kociński

  • 1Department of Pediatric Cardiology and Nephrology, Poznan University of Medical Sciences, Poznan, Poland, jsoltysiak1@gmail.com.

Pediatric Nephrology (Berlin, Germany)
|December 17, 2013
PubMed

Insights

Regional citrate anticoagulation (RCA) is safe and effective for critically ill children undergoing continuous renal replacement therapy (CRRT). RCA demonstrated superior circuit longevity and reduced clotting compared to heparin anticoagulation (HA).

Area of Science:

  • Pediatric Nephrology
  • Critical Care Medicine
  • Renal Replacement Therapy

Background:

  • Continuous renal replacement therapy (CRRT) requires effective anticoagulation to prevent circuit clotting.
  • Regional citrate anticoagulation (RCA) is an alternative to heparin anticoagulation (HA) for CRRT.

Purpose of the Study:

  • To compare the outcomes and complications of RCA-CRRT versus HA-CRRT in critically ill children.
  • To evaluate the safety and efficacy of RCA in pediatric CRRT.

Main Methods:

  • Retrospective review of 30 critically ill children (16 RCA-CRRT, 14 HA-CRRT) undergoing at least 24 hours of CRRT.
  • Utilized a commercially available pre-dilution citrate solution for RCA-CRRT.

Main Results:

  • RCA-CRRT showed significantly higher circuit lifetime (58.04 h vs. 37.64 h) and reduced circuit clotting (11.63% vs. 34.15%) compared to HA-CRRT.
  • While RCA-CRRT had more electrolyte disturbances, it was associated with higher survival rates at discharge (37.5% vs. 14.3%).

Conclusions:

  • Regional citrate anticoagulation (RCA) is safe and effective for low-body-weight, critically ill children requiring CRRT.
  • RCA offers improved circuit lifespan and reduced clotting compared to heparin anticoagulation (HA) in this pediatric population.
Abstract

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