Regional citrate anticoagulation for continuous renal replacement therapy in newborns
Haixia Huang1, Xing Deng1, Ke Bai1
1Intensive Care Unit, Ministry of Education Key Laboratory of Children Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China.
Frontiers in Pediatrics
|March 27, 2023
Summary
Regional citrate anticoagulant (RCA) continuous renal replacement therapy (CRRT) is safe and effective in neonates. Adjustments in RCA-CRRT parameters minimize citrate accumulation risks, showing comparable safety to older populations.
Area of Science:
- Neonatal Intensive Care
- Pediatric Nephrology
- Critical Care Medicine
Background:
- Regional citrate anticoagulant (RCA) is the preferred anticoagulant for continuous renal replacement therapy (CRRT) in adults.
- Its use in neonates is limited due to concerns about immature liver function.
- Few studies have evaluated the safety and efficacy of RCA-CRRT in neonates.
Purpose of the Study:
- To evaluate the safety and efficacy of regional citrate anticoagulant (RCA) in continuous renal replacement therapy (CRRT) for neonates.
- To assess the incidence of citrate accumulation (CA) in neonates undergoing RCA-CRRT.
- To identify factors associated with citrate accumulation in this population.
Main Methods:
- Retrospective observational study of neonates undergoing RCA-CRRT.
- Data collected from September 2015 to January 2021.
- Analysis of total-to-ionized calcium ratio (T/iCa) and citrate accumulation (CA).
Main Results:
- 23 neonates underwent 57 RCA-CRRT sessions.
- Mean filter life was 31.54 hours.
- Citrate accumulation (CA) was not significantly correlated with age or corrected gestational age, and incidence was comparable to adults/children after parameter adjustments.
Conclusions:
- Regional citrate anticoagulant (RCA) continuous renal replacement therapy (CRRT) is safe and effective in neonates.
- Appropriate adjustments in RCA-CRRT parameters can mitigate citrate accumulation.
- Neonatal RCA-CRRT demonstrates safety profiles similar to pediatric and adult populations.
Related Concept Videos
01:30Continuous Renal Replacement Therapy
66
Continuous Renal Replacement Therapy, also known as CRRT, is a procedural treatment for acute kidney injury (AKI) that gradually removes uremic toxins and fluids while maintaining acid-base balance and stabilizing electrolytes. It is particularly useful for hemodynamically unstable patients. Unlike intermittent hemodialysis, which is faster, CRRT provides a gentler approach over 24 hours, closely mimicking the function of natural kidneys. However, CRRT is not ideal for patients with...
66
01:20Acute Kidney Injury V: Interprofessional Care
35
Acute Kidney Injury (AKI) requires a collaborative healthcare approach to restore renal function and prevent complications. Essential management strategies involve monitoring fluid and electrolyte balance, adjusting medications, initiating dialysis when necessary, and providing nutritional support.Fluid and Electrolyte ManagementFluid Monitoring: Regularly monitoring body weight, central venous pressure, and urine output helps detect fluid imbalances early. Patient intake and output are...
35
01:27Parentral Nutrition: Centeral and Peripheral Parental Nutrition
245
Parenteral Nutrition (PN) delivers essential nutrients directly into the bloodstream, bypassing the digestive system. It is commonly used for individuals with severe digestive disorders or conditions that prevent normal nutrient absorption.
PN can be administered through two primary routes:
1. Central Parenteral Nutrition (CPN):
CPN involves delivering a high concentration of nutrients through a large vein. This is typically achieved using a Peripherally Inserted Central Catheter (PICC) or,...
PN can be administered through two primary routes:
1. Central Parenteral Nutrition (CPN):
CPN involves delivering a high concentration of nutrients through a large vein. This is typically achieved using a Peripherally Inserted Central Catheter (PICC) or,...
245
01:28Cardiac Catheterization I: Pre-Procedure Overview
94
Cardiac catheterization is an invasive diagnostic technique used to identify and evaluate structural and functional diseases of the heart and major blood vessels. This technique diagnoses congenital heart disease, coronary artery disease, valvular heart disease, and coronary spasms and assesses ventricular function. It helps guide treatment decisions, including the need for revascularization procedures like percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) and...
94
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention
46
Accurate diagnosis and effective prevention are critical in managing Acute Kidney Injury (AKI), which is linked to high mortality rates ranging from 10% to 80%. Timely recognition of at-risk patients and careful monitoring can significantly reduce the likelihood of kidney damage.Diagnostic Assessments:The diagnostic process starts with a comprehensive medical history to identify prerenal, intrarenal, and postrenal causes.Prerenal causes, such as dehydration, hypotension, or blood loss, should...
46
01:19Imaging Studies VII: Vascular Imaging
37
DefinitionRenal angiography, also known as renal arteriography, is an imaging technique used to obtain a comprehensive view of blood flow and the vascular structure of blood vessels in the kidneys and surrounding areas.PurposeRenal angiography detects blood vessel abnormalities in the kidneys, such as aneurysms, stenosis, thrombosis, vascular tumors, and renal artery stenosis. It evaluates kidney function and guides interventional treatments like angioplasty or stent placement.Pre-Procedure...
37