Incidence of adverse events in patients undergoing continuous renal replacement therapy anticoagulated with sodium citrate

Abstract

Introduction

Acute kidney injury (AKI) is a frequent complication in Intensive Care Unit (ICU) patients with high morbidity and mortality.

Objective

To analyze the incidence of mechanical and metabolic adverse events associated with continuous renal replacement therapy using sodium citrate as a regional anticoagulant.

Material and methods

Observational, descriptive and prospective study performed in a polyvalent ICU during three years. Patients with AKI treated with renal replacement therapy and sodium citrate (Prismocitrate 18/0 mmol/L [0.5%]) were included. Patients with liver failure, active bleeding, severe thrombocytopenia, ICU stay of less than 24 h or treated with other anticoagulants were excluded. Demographic variables, severity index (APACHE II), vasoactive drug use, adverse events, and catheter characteristics were recorded. Anticoagulation efficacy was assessed with filter duration. Statistical analysis was performed with SPSS v.28.0, with P < .05 as the significance level. The study was approved by the ethics committee and informed consent was obtained from the patients or their relatives.

Results

We studied 100 patients, 62% men, with a mean age of 63 ± 14.5 years. The main causes of AKI were septic shock, hemorrhagic shock and Covid-19. The median ICU stay was 16 days (RIC 8–43), with intra-ICU mortality of 48%. Therapy lasted a median of 60.5 h (RIC 38–107). Only one patient presented bleeding, and in 26% the filter coagulated. There were no cases of citrate toxicity. Electrolyte complications included hypocalcemia (45%), hypokalemia (41%), hyponatremia (36%) and metabolic acidosis (30%).

Conclusions

Mechanical and metabolic complications are common in continuous renal replacement therapies with sodium citrate. It is essential for ICU staff to be aware of their high prevalence in order to optimize clinical management.