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Circuit Lifetime With Citrate Versus Heparin in Pediatric Continuous Venovenous Hemodialysis

Tomáš Zaoral1, Michal Hladík, Jana Zapletalová

  • 11Pediatric Intensive Care Unit, Department of Pediatrics, Faculty of Medicine, University Hospital Ostrava, Ostrava, Czech Republic. 2The Department of Medical Biophysics, Faculty of Medicine, University hospital Olomouc, Olomouc, Czech Republic.

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
|July 19, 2016
PubMed

Insights

Regional citrate anticoagulation significantly extended circuit lifetimes compared to heparin during continuous venovenous hemodialysis in pediatric patients. Citrate also reduced transfusion needs, proving safe and effective.

Area of Science:

  • Pediatric Nephrology
  • Critical Care Medicine
  • Renal Replacement Therapy

Background:

  • Continuous venovenous hemodialysis (CVVH) is crucial for pediatric patients with acute kidney injury.
  • Anticoagulation is essential for maintaining CVVH circuit patency.
  • Regional citrate anticoagulation (RCA) is an alternative to systemic heparin, but its efficacy in children requires further investigation.

Purpose of the Study:

  • To compare the effectiveness of regional citrate anticoagulation versus global heparinized anticoagulation on circuit survival during pediatric CVVH.
  • To evaluate the impact of these anticoagulation methods on transfusion requirements.

Main Methods:

  • A prospective cross-over trial was conducted involving 63 pediatric patients (0-18 years) undergoing CVVH.
  • Each patient received four CVVH circuits, alternating between heparin and citrate anticoagulation.
  • Circuit life was defined as the time until transmembrane pressure reached ≥250 mm Hg for >60 minutes.

Main Results:

  • Citrate demonstrated a significantly longer median circuit lifetime (41.0 hours) compared to heparin (36.0 hours; p=0.0001).
  • Transfusion rates were lower with citrate (0.17 units/circuit) than with heparin (0.36 units/circuit; p=0.002).
  • Circuit lifetime showed significant correlations with patient age, weight, and blood flow rate.

Conclusions:

  • Regional citrate anticoagulation offers superior circuit longevity compared to heparin in pediatric CVVH.
  • Citrate is associated with reduced blood product transfusion needs.
  • Citrate anticoagulation is a feasible and safe option for infants and children requiring CVVH.
Abstract

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