Regional Citrate vs. Systemic Unfractionated Heparin Anticoagulation for Continuous Renal Replacement Therapy in Paediatric Patients: Systematic Review and Meta-Analysis.

Abstract

The efficacy and safety of unfractionated heparin (UFH) and regional citrate anticoagulation (RCA) in continuous renal replacement therapy (CRRT) are subjects of controversy across paediatric patients. We conducted a search of the PubMed, Embase and Cochrane Library databases from inception to 2024. The Newcastle-Ottawa Scale was used to assess the quality of the included studies. Sensitivity analysis confirmed the stability of results; publication bias was investigated by Egger test. We conducted a search of the PubMed, Embase and Cochrane Library databases from inception to 2024, and 12 studies were included. Compared with UFH, RCA significantly prolonged circuit survival time (WMD 12.09, 95% CI: [4.48, 19.71], p = 0.002), reduced the risk of filter clotting (RR = 0.60, 95% CI: [0.42-0.85], p = 0.004) and bleeding (RR = 0.42, 95% CI: [0.23-0.79], p = 0.007). Although citrate anticoagulation was more likely to cause metabolic alkalosis (RR = 3.22, 95% CI: [1.34-7.75], p = 0.009) and hypocalcemia (RR = 2.92, 95% CI: [1.93-4.41], p < 0.001), metabolic complications were manageable and mild. Further subgroup analysis of paediatrics showed that, compared with children with an average weight > 10 kg, citrate anticoagulation significantly extended the circuit survival time of children with an average weight ≤ 10 kg (p < 0.001). Sensitivity analysis confirmed that the results were generally robust. RCA could be the first choice for anticoagulation in paediatrics, especially for infants weighing ≤ 10 kg.