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

Abstract

Background: 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.

Materials and methods: 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.

Results: 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.

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