The efficacy and safety of regional citrate anticoagulation for continuous renal replacement therapy
Abstract：Objective To investigate the efficacy and safety of regional citrate anticoagulation in critically ill patients treated with continuous renal replacement therapy ( CRRT ) . Methods A prospective study was conducted on the patients treated with CRRT in our hospital from July 2012 to December 2013.At start of CVVH, baseline data of the patients was collected , including recent surgery, platelets, international normalized ratio (INR), activated partial thromboplastin time (APTT), blood urea nitrogen (BUN) and serum creatinine (Cr), total bilirubin (TBIL),acute physiology and chronic health evaluation ( APACHEⅡ), sequential organ failure assessment ( SOFA).Also, the survival time of the filters , bleeding complication , acid-base imbalance , electrolyte disturbance were recorded during CRRT .Based on different anticoagulation , the CRRT was divided into three groups:non-anticoagulation group , heparin anticoagulation group and regional citrate anticoagulation ( RCA ) group.The survival time of the filters was analyzed among the three groups , the relationship among baseline characteristics , anticoagulation ways and the survival time of the filters was observed by multiple linear regression analysis , and the relationship was analyzed among baseline characteristics , anticoagulation ways and risk for bleeding complication by Logistic regression analysis .The Bleeding complication, thrombocytopenia , metabolic complication were compared with Chi -square statistics between groups.Results 75 critically ill patients who received 295 times of CRRT.Based on different anticoagulation , with 97 times in non-anticoagulation group , 110 times in heparin anticoagulation group and 88 times in citrate anticoagulation group .The survival time of the filters was (18.24 ±1.09) hours in no anticoagulation group, (24.53 ±1.60) hours in heparin anticoagulation group, and (27.12 ± 1.55 ) hours in RCA group .The survival time of the filters was longer in the heparin anticoagulation group and the RCA group than the non -anticoagulation group (P<0.01), and there was no significant differences between heparin anticoagulation group and RCA group .Anticoagulation ways and baseline platelets were significantly associated with the survival time of the filter ,the regression coefficients of the anticoagulation ways and baseline platelets were 0.20 (P<0.05) and 0.18 (P<0.05), respectively. For bleeding risk, no correlation existed between the anticoagulation ways and bleeding risk [OR 3.03, P>0.05].Recent surgery was the independent risk factor in relation to bleeding (OR 26.67, P<0.05 ) .Bleeding complication , thrombocytopenia , metabolic complication were observed no statistically significant differences in three groups ( P>0.05 ) .Conclusion The efficacy of anticoagulation was comparable between the RCA group and the heparin anticoagulation group , but superior to the non -anticoagulation group during CRRT .The survival time of the filters was mainly associated with the anticoagulation ways and baseline platelets .Recent surgery was the independent risk factor in relation to bleeding during CRRT .Additionally , no significant correlation between bleeding complications and the anticoagulation ways was observed .
Keywords：Continuous renal replacement therapy(CRRT)AnticoagulationRegional citrate anticoagulation(RCA)Efficacy
Publication Date：2015-01-01
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：6( 849-853,854 )