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Comparison of different modalities of continuous renal replacement therapy with regional sodium citrate

Jie He1, Zhenghui Xiao1, Xiong Zhou1

  • 1Paediatric Intensive Care Unit, Hunan Children's Hospital, Changsha, Hunan, China.

The International Journal of Artificial Organs
|July 29, 2022
PubMed

Insights

Continuous venovenous haemodiafiltration (CVVHDF) offers a longer filter lifespan and comparable safety to continuous venovenous haemofiltration (CVVH) for pediatric patients undergoing regional citrate anticoagulation continuous renal replacement therapy (RCA-CRRT).

Area of Science:

  • Pediatric Nephrology
  • Critical Care Medicine
  • Renal Replacement Therapy

Background:

  • Continuous renal replacement therapy (CRRT) is crucial for critically ill children with kidney failure.
  • Regional citrate anticoagulation (RCA) is an alternative to heparin for CRRT, potentially reducing bleeding risks.
  • Evaluating different CRRT modalities with RCA in pediatric populations is essential for optimizing treatment.

Purpose of the Study:

  • To compare the efficacy and safety of continuous venovenous haemofiltration (CVVH) versus continuous venovenous haemodiafiltration (CVVHDF) using RCA in pediatric patients.
  • To assess filter lifespan and complication rates between CVVH and CVVHDF in this population.

Main Methods:

  • A retrospective study reviewed 80 pediatric patients undergoing RCA-CRRT (CVVH or CVVHDF) from April 2017 to March 2021.
  • Patients receiving continuous venovenous haemodialysis were excluded due to small numbers.
  • Filter lifespan and complication incidence were compared between CVVH and CVVHDF groups.

Main Results:

  • CVVHDF demonstrated a significantly longer filter lifespan (median 47 hours) compared to CVVH (median 35 hours) (p=0.029).
  • The hazard ratio for filter lifespan was higher in the CVVH group (3.023, p<0.001).
  • Both modalities showed similar rates of metabolic alkalosis, hyperlactataemia, hypocalcaemia, and hypercalcaemia, with no citrate accumulation or hypernatraemia observed.

Conclusions:

  • CVVHDF is a more effective modality than CVVH for RCA-CRRT in children, primarily due to extended filter survival.
  • Both CVVH and CVVHDF with RCA appear to be safe in pediatric patients, with comparable complication profiles.
  • These findings support the use of CVVHDF for RCA-CRRT in pediatric intensive care settings.
Abstract

Keywords:
Continuous renal replacement therapycontinuous venovenous haemodiafiltrationcontinuous venovenous haemofiltrationpaediatricsrenal replacement therapysodium citrate

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