Complications of Regional Citrate Anticoagulation for Continuous Renal Replacement Therapy: An Observational Study.

Details

Serval ID
serval:BIB_6B87462B961D
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Complications of Regional Citrate Anticoagulation for Continuous Renal Replacement Therapy: An Observational Study.
Journal
Blood purification
Author(s)
Bianchi N.A., Altarelli M., Eckert P., Schneider A.G.
ISSN
1421-9735 (Electronic)
ISSN-L
0253-5068
Publication state
Published
Issued date
2020
Peer-reviewed
Oui
Volume
49
Number
5
Pages
567-575
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
Regional citrate anticoagulation (RCA) is the recommended anticoagulation modality for continuous renal replacement therapy (CRRT). RCA was associated with a low rate of complications in randomized controlled trials. However, little is known about the type and rate of complications in real life. We sought to describe complications associated with RCA in comparison with those associated with heparin anticoagulation.
In our institution, RCA has been the default anticoagulation modality for CRRT in all patients without contraindications since 2013. We have retrospectively reviewed all consecutive patients who received CRRT between January and December 2016 in our institution. For each CRRT session, we have assessed circuit duration, administered dose, as well as therapy-associated complications. Those parameters were compared according to whether the circuit was run in continuous veno-venous hemodialysis (CVVHD) mode with RCA or continuous veno-venous hemofiltration (CVVH) mode with heparin anticoagulation.
We analyzed 691 CRRT sessions in 121 patients. Of those 400 (57.9%) were performed in CVVHD-RCA mode and 291 (42.1%) in CVVH-Heparin Mode. Compared with -CVVH-Heparin mode, CVVHD-RCA mode was associated with a longer circuit lifespan (median duration 54.9 interquartile range [IQR 44.6] vs. 15.3 h [IQR 22.4], p < 0.0001). It was associated with a higher rate of metabolic acidosis 77 (20.2%) vs. 18 (7.2%), (p < 0.0001), alkalosis 186 (48.7%) vs. 43 (17.1%), (p= 0.0001), and hypocalcemia 96 (25.07%) vs. 26 events (10.79%), p < 0.0001. However, the majority of these alterations were of benign or moderate severity. Only one possible citrate intoxication was observed.
CVVHD-RCA was associated with a much longer circuit life but an increased rate of minor metabolic complications, in particular acid-base derangements. Some of these complications might have been prevented by therapy adaptation. Medical and nursing staff education is of major importance in the implementation of an RCA protocol.
Keywords
Acute kidney failure, Continuous renal replacement therapy, Dialysis, Metabolic complications, Regional citrate anticoagulation, Renal replacement therapy, Continuous renal replacement therapy
Pubmed
Web of science
Open Access
Yes
Create date
05/03/2020 16:02
Last modification date
20/01/2021 20:31
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