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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 J+Intensive+Care+Soc
2017 ; 18
(3
): 184-192
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Evaluating the safety and efficacy of regional citrate compared to systemic
heparin as anticoagulation for continuous renal replacement therapy in critically
ill patients: A service evaluation following a change in practice
#MMPMID29118829
Borg R
; Ugboma D
; Walker DM
; Partridge R
J Intensive Care Soc
2017[Aug]; 18
(3
): 184-192
PMID29118829
show ga
Following the implementation of citrate anticoagulation for continuous renal
replacement therapy, we evaluate its first year of use and compare it to the
previously used heparin, to assess whether our patients benefit from the recently
reported advantages of citrate. We retrospectively analysed 2 years of data to
compare the safety and efficacy of citrate versus heparin. The results have shown
that 43 patients received continuous renal replacement therapy with heparin, 37
patients with citrate. We found no significant difference in metabolic control of
pH, urea and creatinine after 72?h. Filters anticoagulated with citrate had
significantly longer median lifespan (33?h vs 17?h; p?=?0.001), shorter downtime
(0?h vs 5?h; p?=?0.015) and less filter sets per patient day (0.37 vs 0.67;
p?=?0.002). Filters anticoagulated with heparin were commonly interrupted due to
clotting (50% vs 16.4%), whereas filters anticoagulated with citrate were often
stopped electively (53.4% vs 24.6%). Patients on heparin filters had
significantly higher APPTs, some at potentially dangerous levels (>180?s), whilst
patients on citrate filters had significantly higher levels of bicarbonate.
Therefore, we conclude that citrate is superior in terms of safety and efficacy,
with longer filter lifespan. It has become our first line anticoagulant for
continuous renal replacement therapy.