Introduction
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.
Methods
In our institution, RCA has been the default anticoagulation modality for CRRT in all patients without
contra-indications 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.
Results
We analyzed 691 CRRT sessions in 121 patients. Of those 400 (57.9%) were performed in CVVHDRCA
mode and 291 (42.1%) in CVVH-Heparin Mode. Compared with CVVH-Heparin mode, CVVHDRCA
mode was associated with a longer circuit lifespan (median duration 54.9 (IQR 44.6) vs 15.3
hours (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.
Conclusions
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 a RCA protocol.