Regional citrate anticoagulation for continuous renal replacement therapy: a prospective study in a resource-limited...

Regional citrate anticoagulation has advantages over systemic heparin in prolonging filter life and decreasing bleeding risk during continuous renal replacement therapy (CRRT). However, implementing regional citrate anticoagulation in resource-limited intensive care units (ICU) remains challenging due to potential adverse events and the absence of standardized protocols. This study aims to evaluate the efficacy and safety of regional citrate anticoagulation in CRRT for critically ill patients in low-resource settings.

This single-center, prospective cohort study enrolled critically ill patients with acute kidney injury (AKI) requiring CRRT at a resource-limited ICU in Vietnam. Patients received either regional citrate anticoagulation or heparin anticoagulation. Primary outcomes included filter lifespan and adverse events; secondary outcomes were renal recovery and in-hospital mortality rate.

One hundred twenty-one patients were enrolled, 42 in the citrate group and 79 in the heparin group. The citrate group had a significantly longer filter lifespan (median 56 h versus 31 h; p < 0.001) and a lower rate of premature (< 24 h) filter clotting (4.8% versus 27.2%, p < 0.001). The hemorrhage rate was 6.4% in the citrate group versus 12.9% in the heparin group (p = 0.162). However, hypomagnesemia occurred more frequently in the citrate group (58.7% versus 23.1%, p < 0.001). No significant differences in renal recovery or hospital mortality were observed between groups.

Regional citrate anticoagulation effectively maintained filter patency and proved to be safe for CRRT in a resource-limited ICU. Further studies are needed to establish standardized protocols for regional citrate anticoagulation in this setting to minimize citrate-related adverse events.