Regional citrate anticoagulation for continuous renal replacement therapy in children
Mayerly Prada Rico1, Jaime Fernández Sarmiento2, Ana María Rojas Velasquez3
1Division of Pediatric Nephrology, Department of Pediatrics, Fundación Cardioinfantil IC, Instituto de Cardiologia, Bogota, Cundinamarca, Colombia.
Insights
Regional citrate anticoagulation significantly extends hemofilter lifespan compared to heparin in pediatric continuous renal replacement therapy (CRRT). This finding improves CRRT circuit management for critically ill children.
Area of Science:
- Pediatric Nephrology
- Critical Care Medicine
- Medical Device Technology
Background:
- Anticoagulation is crucial for continuous renal replacement therapy (CRRT) circuit patency.
- Limited evidence exists on citrate anticoagulation efficacy in pediatric CRRT.
- This study addresses the gap by comparing citrate and heparin in children.
Purpose of the Study:
- To compare regional citrate anticoagulation (RCA) with systemic heparin anticoagulation (SHA).
- To evaluate the impact on hemofilter lifetime in pediatric CRRT patients.
- To provide evidence for optimizing anticoagulation strategies in pediatric critical care.
Main Methods:
- Retrospective cohort study analyzing 150 hemofilters over 3442 CRRT hours.
- Compared hemofilter survival in citrate (n=80) versus heparin (n=70) groups.
- Defined hemofilter survival by time to clotting or high transmembrane pressure.
Main Results:
- Hemofilter survival was significantly higher with citrate (72 hours) versus heparin (18 hours) (p <0.0001).
- Heparin use increased hemofilter coagulation risk (Hazard Ratio 3.70, p <0.00001).
- Results were consistent across different hemofilter sizes and pump flows.
Conclusions:
- Regional citrate anticoagulation appears more effective than heparin.
- Citrate prolongs hemofilter lifetime in pediatric patients undergoing CRRT.
- This suggests RCA as a potentially superior anticoagulation strategy for pediatric acute kidney injury.
Background:
Anticoagulation of the continuous renal replacement therapy (CRRT) circuit is an important technical aspect of this medical procedure. Most studies evaluating the efficacy and safety of citrate use have been carried out in adults, and little evidence is available for the pediatric patient population. The aim of this study was to compare regional citrate anticoagulation versus systemic heparin anticoagulation in terms of the lifetime of hemofilters in a pediatric population receiving CRRT at a pediatric center in Bogota, Colombia.
Methods:
This was an analytical, observational, retrospective cohort study in which we assessed the survival of 150 hemofilters (citrate group 80 hemofilters, heparin group 70 hemofilters) used in a total of 3442 hours of CCRT (citrate group 2248 h, heparin group 1194 h). Hemofilter survival was estimated beginning at placement and continuing until filter replacement due to clotting or high trans-membrane pressures.
Results:
Hemofilter survival was higher in the citrate group than in the heparin group (72 vs. 18 h; p <0.0001). Bivariate analysis showed that the hemofilter coagulation risk was significantly increased when heparin was used, regardless of hemofilter size and pump flow (hazard ratio 3.70, standard error 0.82, 95% confidence interval 2.39-5.72; p <0.00001).
Conclusions:
Regional citrate anticoagulation could be more effective than heparin systemic anticoagulation in terms of prolonging the hemofilter lifetime in patients with acute renal injury who require CRRT.
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