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Regional Citrate vs. Systemic Unfractionated Heparin Anticoagulation for Continuous Renal Replacement Therapy in

Yi Wang1, Lan Yang1, Yaping Liu1

  • 1Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China.

Nephrology (Carlton, Vic.)
|August 11, 2025
PubMed

Insights

Regional citrate anticoagulation (RCA) is superior to unfractionated heparin (UFH) for continuous renal replacement therapy in children. RCA prolonged circuit survival and reduced clotting and bleeding risks, making it a preferred choice, especially for infants.

Area of Science:

  • Pediatric Nephrology
  • Critical Care Medicine
  • Pharmacology

Background:

  • Continuous renal replacement therapy (CRRT) requires effective anticoagulation in pediatric patients.
  • Unfractionated heparin (UFH) and regional citrate anticoagulation (RCA) are common methods, but their comparative efficacy and safety in children remain debated.

Purpose of the Study:

  • To compare the efficacy and safety of RCA versus UFH for anticoagulation in pediatric patients undergoing CRRT.
  • To identify the optimal anticoagulation strategy for different pediatric subgroups.

Main Methods:

  • A systematic review and meta-analysis of studies from PubMed, Embase, and Cochrane Library databases (inception to 2024).
  • Quality assessment using the Newcastle-Ottawa Scale.
  • Sensitivity analysis and Egger's test for publication bias were performed.

Main Results:

  • RCA significantly prolonged circuit survival time (WMD 12.09, p=0.002) and reduced filter clotting (RR=0.60, p=0.004) and bleeding risks (RR=0.42, p=0.007) compared to UFH.
  • While RCA increased the risk of metabolic alkalosis (RR=3.22, p=0.009) and hypocalcemia (RR=2.92, p<0.001), these were manageable.
  • RCA significantly extended circuit survival in children weighing ≤10 kg (p<0.001).

Conclusions:

  • RCA is a more effective and safer anticoagulation strategy than UFH in pediatric CRRT.
  • RCA is particularly beneficial for infants and children weighing ≤10 kg.
  • RCA should be considered the first-choice anticoagulation method in pediatric CRRT.

Keywords:
anticoagulationcitratescontinuous renal replacement therapyheparinpaediatrics

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