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Semiautomated Regional Citrate Anticoagulation for Continuous Kidney Replacement Therapy: An Observational Study in

Jean-Michel Liet1, Julien Baleine2, Pierre Demaret3

  • 1Division of Pediatric Critical Care Medicine, Department of Neonatal Medicine and Pediatric Intensive Care, University Hospital of Nantes, Nantes, France.

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
|May 18, 2022
PubMed

Insights

Semiautomated regional citrate anticoagulation (saRCA) is feasible for continuous kidney replacement therapy (CKRT) in children under 11 kg. Strict protocols and training are essential to manage complications like citrate intoxication.

Area of Science:

  • Pediatric Nephrology
  • Critical Care Medicine
  • Renal Replacement Therapy

Background:

  • Continuous kidney replacement therapy (CKRT) is vital for critically ill children with kidney failure.
  • Regional citrate anticoagulation (RCA) is an alternative to systemic heparinization, potentially reducing bleeding complications.
  • Semiautomated RCA (saRCA) offers a more standardized approach to citrate anticoagulation during CKRT.

Purpose of the Study:

  • To review the utilization and outcomes of saRCA for CKRT in young children weighing less than 11 kg.
  • To identify the incidence of citrate intoxication and unscheduled interruptions during saRCA in this pediatric population.

Main Methods:

  • Retrospective cohort study conducted across three pediatric intensive care units (PICUs).
  • Analysis of data from consecutive children weighing less than 11 kg who received CKRT with saRCA between January 2015 and June 2020.
  • Evaluation of CKRT session duration, number of sessions, citrate intoxication events, and unscheduled interruptions.

Main Results:

  • Twenty-one children weighing less than 11 kg underwent CKRT with saRCA, totaling 2,014 hours across 64 sessions.
  • Citrate intoxication occurred in 6% of sessions (4/64), specifically when initial lactate was >4 mmol/L or replacement fluid to citrate flow ratio was <50%.
  • The rate of unscheduled CKRT interruptions was 25% (16/64).

Conclusions:

  • Semiautomated regional citrate anticoagulation can be utilized for CKRT in neonates and young children weighing less than 11 kg.
  • Implementation requires a strict protocol and intensive staff training to minimize the risk of citrate intoxication and other complications.
  • Careful monitoring of lactate levels and fluid flow ratios is crucial for safe saRCA use in this vulnerable population.
Abstract

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