Related Experiment Video
Updated: Jul 5, 2025
Author Spotlight: Simulating Pediatric Cardiac Surgery Using a Neonatal Piglet Model
Published on: May 26, 2023
Citrate anticoagulation in plasma exchange followed by continuous renal replacement therapy in critically ill
Zhang Xinping1, He Jie1, Yao Zhenya1
1Department of Critical Care Medicine, Hunan Children's Hospital, Changsha, Hunan, China.
Insights
Regional citrate-anticoagulated plasma exchange (RCA-PE) showed superior filter performance in critically ill children. Sequential continuous renal replacement therapy (CRRT) effectively improved citrate-related metabolic alkalosis following RCA-PE.
Area of Science:
- Pediatric Critical Care Medicine
- Renal Replacement Therapy
- Extracorporeal Therapies
Background:
- Plasma exchange (PE) is crucial for critically ill children but requires effective anticoagulation.
- Regional citrate anticoagulation (RCA) is an alternative to systemic heparin anticoagulation (SHA) during PE.
- Citrate accumulation can lead to metabolic disturbances, necessitating careful monitoring and management.
Purpose of the Study:
- To evaluate the efficacy and safety of RCA-PE in critically ill children.
- To determine if continuous renal replacement therapy (CRRT) can mitigate citrate-related metabolic disorders after RCA-PE.
- To compare RCA-PE with SHA-PE in terms of filter performance and metabolic outcomes.
Main Methods:
- A retrospective, single-center observational study of 79 critically ill children undergoing PE followed by CRRT.
- Patients were divided into RCA-PE (n=30) and SHA-PE (n=49) groups.
- Filter performance and metabolic parameters (pH, HCO₃⁻) were assessed pre- and post-PE and CRRT.
Main Results:
- RCA-PE demonstrated superior filter performance compared to SHA-PE.
- RCA-PE was associated with a higher incidence of metabolic alkalosis (48.3%) initially.
- Sequential CRRT significantly reduced metabolic alkalosis in the RCA-PE group (13.8%), normalizing outcomes compared to SHA-PE.
Conclusions:
- Regional citrate anticoagulation offers better filter performance during plasma exchange in critically ill children.
- Continuous renal replacement therapy effectively manages metabolic alkalosis associated with RCA-PE.
- RCA-PE followed by CRRT is a viable and improved alternative for anticoagulation in pediatric PE.
Objective:
To investigate the effectiveness and safety of regional citrate-anticoagulated (RCA) plasma exchange (PE) and whether citrate-related metabolic disorders can be improved by sequential RCA continuous renal replacement therapy (CRRT).
Methods:
This retrospective, single-center observational study included 79 critically ill children requiring PE followed by CRRT (June 2018 to June 2021) at the Pediatric Intensive Care Unit of Hunan Children's Hospital, China. Patients were divided into the RCA-PE (n = 30) and systemic heparin anticoagulation (SHA-PE) (n = 49) groups. Filter level comparison post-PE assessed RCA-PE efficacy, and metabolic changes occurring pre- and post-PE and CRRT were used to evaluate the effect of CRRT on RCA-based anticoagulation safety.
Results:
The RCA-PE group had a better overall filter performance than the SHA-PE group. Two hours after PE, pH and HCO₃- levels increased more significantly for the RCA-PE than the SHA-PE group. The RCA-PE incidence of metabolic alkalosis was 48.3%, higher by 4.2% (p < 0.001) compared to the SHA-PE group. In the RCA-PE group, pH and HCO₃- decreased significantly 4 h after CRRT; the metabolic alkalosis caused by RCA-PE decreased to 13.8% (p = 0.005). No significant difference in pH, HCO₃-, and metabolic alkalosis incidence was observed between the two groups 4 h after CRRT.
Conclusions:
The overall filtration performance of RCA-PE is superior to that of SHA-PE followed by CRRT. The metabolic complications associated with RCA-PE are mainly metabolic alkalosis that can be improved by using CRRT after RCA-PE and this is a better alternative for anticoagulation during PE in critically ill children.
More Related Videos
05:23Continuous Manual Exchange Transfusion for Patients with Sickle Cell Disease: An Efficient Method to Avoid Iron Overload
Published on: March 14, 2017
08:44Continuous IV Infusion is the Choice Treatment Route for Arginine-vasopressin Receptor Blocker Conivaptan in Mice to Study Stroke-evoked Brain Edema
Published on: September 1, 2016
Related Concept Videos
01:27Dialysis
Acute kidney injury develops suddenly and can be caused by pre-renal causes (e.g., hypovolemia, shock), intrinsic renal causes (e.g., acute tubular necrosis), or post-renal causes (e.g., urinary obstruction). In contrast, chronic renal failure progresses gradually over time and is often...
01:30Anticoagulant Drugs: Low-Molecular-Weight Heparins
01:27Parentral Nutrition: Centeral and Peripheral Parental Nutrition
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,...