Efficacy of Regional Citrate versus Heparin Anticoagulation in Continuous Renal Replacement Therapy

Continuous renal replacement therapy (CRRT) is used in hemodynamically unstable patients with acute kidney injury (AKI). Heparin, the most commonly used anticoagulant, has a significant bleeding risk and is associated with heparin-induced thrombocytopenia. Regional citrate anticoagulation is an alternative anticoagulation strategy in CRRT.

A randomized controlled trial was conducted in the Intensive Care Unit over one year, from October 2020 to September 2021, in patients with AKI requiring CRRT. Fifty-two patients were randomized into two groups: group 1 received regional citrate anticoagulation, and group 2 received heparin anticoagulation.

The mean age in group 1 was 50.46 years, while it was 49.35 years in group 2. The mean filter lifespan in group 1 was 45.11 hours, while in group 2, it was 26.11 hours and was statistically significant (P < 0.001). The mean effective delivered RRT dose was higher in group 1 (26 ml/kg/hour) compared to group 2 (24.23 ml/kg/hour), which was statistically significant (P < 0.001). Bleeding episodes were higher in group 2 than in group 1 (42.3% vs 11.5%), which was statistically significant (P = 0.027). The RCA group had various electrolyte and metabolic complications, but these were not statistically significant.

Regional citrate anticoagulation is better than heparin anticoagulation in terms of filter lifespan, effective delivered RRT dose, bleeding episodes, and metabolic complications.