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Citrate versus heparin anticoagulation in continuous renal replacement therapy in small children

Paulien A M A Raymakers-Janssen1, Marc Lilien2, Ingrid A van Kessel3

  • 1Department of Pediatric Intensive Care, Wilhelmina Children's Hospital, University Medical Center Utrecht, Lundlaan 6, 3584 EA, Utrecht, The Netherlands. p.a.m.a.raymakers-janssen@umcutrecht.nl.

Pediatric Nephrology (Berlin, Germany)
|June 5, 2017
PubMed

Insights

Citrate anticoagulation in pediatric continuous renal replacement therapy (CRRT) significantly extends circuit survival time compared to heparin. This study demonstrates citrate

Area of Science:

  • Pediatric Nephrology
  • Critical Care Medicine
  • Biomedical Engineering

Background:

  • Heparin is the standard anticoagulant for adult continuous renal replacement therapy (CRRT).
  • Limited data exists on citrate's safety and efficacy in pediatric CRRT, especially in infants and toddlers.
  • Adverse effects of citrate in this population are not well-documented.

Purpose of the Study:

  • To prospectively evaluate the use of citrate as an anticoagulant in critically ill small children undergoing CRRT.
  • To compare circuit survival time between citrate and heparin anticoagulation in pediatric CRRT.
  • To assess the safety of citrate, including toxicity and electrolyte balance, in this patient group.

Main Methods:

  • A prospective study involving critically ill children who underwent CRRT with small filters.
  • Patients received either heparin or citrate anticoagulation per a strict protocol.
  • Primary outcome was circuit survival time; secondary outcomes included alkalosis, citrate toxicity, and red blood cell transfusions.

Main Results:

  • Citrate use resulted in significantly longer median circuit survival time (45.2 hours) compared to heparin (21 hours) (p < 0.001).
  • No citrate toxicity was observed in patients receiving citrate anticoagulation.
  • No significant differences in electrolyte balance or red blood cell transfusions were noted between the two groups.

Conclusions:

  • Regional citrate anticoagulation significantly prolongs circuit survival time in pediatric CRRT, enhancing treatment efficiency.
  • Citrate is a safe and effective anticoagulant for CRRT in critically ill small children.
  • These findings support the wider adoption of citrate in pediatric CRRT.
Abstract

Keywords:
AnticoagulationChildrenCitrateContinuous renal replacement therapyHeparin

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