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Direct Drug Delivery to Kidney via the Renal Artery
Published on: April 17, 2021
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Anticoagulation strategies in continuous renal replacement therapy.
Matthieu Legrand1,2, Ashita Tolwani3
1Department of Anesthesia and Perioperative Care, Division of Critical Care Medicine, UCSF School of Medicine, San Francisco, CA, USA.
Seminars in Dialysis
|March 8, 2021
Summary
Regional citrate anticoagulation (RCA) is recommended over unfractionated heparin (UFH) for continuous renal replacement therapy (CRRT) when feasible. Careful patient assessment and monitoring are crucial for selecting the optimal anticoagulant strategy.
Area of Science:
- Nephrology
- Critical Care Medicine
- Pharmacology
Background:
- Continuous renal replacement therapy (CRRT) requires anticoagulation to maintain circuit patency.
- Common anticoagulation methods include unfractionated heparin (UFH), regional citrate anticoagulation (RCA), and no anticoagulation.
- Less common options involve UFH with protamine, low-molecular weight heparin (LMWH), thrombin antagonists, and antiplatelet agents.
Purpose of the Study:
- To review anticoagulant options for CRRT.
- To highlight the KDIGO guidelines' recommendations for CRRT anticoagulation.
- To emphasize factors influencing anticoagulant choice and monitoring.
Main Methods:
- Literature review of anticoagulation strategies for CRRT.
- Analysis of current guidelines, specifically KDIGO.
- Discussion of patient-specific factors and monitoring parameters.
Main Results:
- Regional citrate anticoagulation (RCA) is preferred over unfractionated heparin (UFH) by KDIGO guidelines for CRRT, barring contraindications.
- Patient characteristics, local expertise, and monitoring ease guide anticoagulant selection.
- Monitoring encompasses anticoagulant effect, circuit lifespan, filter performance, and complications.
Conclusions:
- The choice of anticoagulant for CRRT is multifactorial, balancing efficacy, safety, and patient status.
- Regional citrate anticoagulation (RCA) offers a favorable option for many CRRT patients.
- Comprehensive monitoring is essential for safe and effective CRRT anticoagulation.
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