Beyond the Randomized Clinical Trial: Citrate for Continuous Renal Replacement Therapy in Clinical Practice

TY - JOUR

T1 - Beyond the Randomized Clinical Trial

T2 - Citrate for Continuous Renal Replacement Therapy in Clinical Practice

AU - Tovey, L.

AU - Dickie, H.

AU - Gangi, S.

AU - Terblanche, M.

AU - McKenzie, C.

AU - Beale, R.

AU - Treacher, David

AU - Ostermann, M.

PY - 2013/12/1

Y1 - 2013/12/1

N2 - Background: Premature circuit clotting is a major problem during continuous renal replacement therapy (CRRT). Six randomized controlled trials confirmed that regional anticoagulation with citrate is superior to heparin. Our objective was to compare circuit patency with citrate, heparin and epoprostenol in routine clinical practice. Methods: We retrospectively analysed data on circuit patency of all circuits used in a single centre between September 2008 and August 2009. We differentiated between premature filter clotting, elective discontinuation and waste. Results: 309 patients were treated with CRRT (n = 2,059 circuits). The mean age was 65.7; 63.8% were male. The methods to maintain circuit patency were unfractionated heparin (42.3%), epoprostenol (23.0%), citrate (14.7%), combinations of different anticoagulants (14.6%) and no anticoagulation (4.7%). Premature clotting was the most common reason for circuit discontinuation among circuits anticoagulated with heparin, epoprostenol or combinations of different anticoagulants (59-62%). Among circuits anticoagulated with citrate the main reason for discontinuation was elective (61%). Hazard regression analysis confirmed significantly better circuit survival with citrate. Changing from heparin to citrate decreased the risk of premature circuit clotting by 75.8%. Conclusion: In routine clinical practice, regional anticoagulation with citrate is associated with significantly better circuit patency than heparin or epoprostenol.

AB - Background: Premature circuit clotting is a major problem during continuous renal replacement therapy (CRRT). Six randomized controlled trials confirmed that regional anticoagulation with citrate is superior to heparin. Our objective was to compare circuit patency with citrate, heparin and epoprostenol in routine clinical practice. Methods: We retrospectively analysed data on circuit patency of all circuits used in a single centre between September 2008 and August 2009. We differentiated between premature filter clotting, elective discontinuation and waste. Results: 309 patients were treated with CRRT (n = 2,059 circuits). The mean age was 65.7; 63.8% were male. The methods to maintain circuit patency were unfractionated heparin (42.3%), epoprostenol (23.0%), citrate (14.7%), combinations of different anticoagulants (14.6%) and no anticoagulation (4.7%). Premature clotting was the most common reason for circuit discontinuation among circuits anticoagulated with heparin, epoprostenol or combinations of different anticoagulants (59-62%). Among circuits anticoagulated with citrate the main reason for discontinuation was elective (61%). Hazard regression analysis confirmed significantly better circuit survival with citrate. Changing from heparin to citrate decreased the risk of premature circuit clotting by 75.8%. Conclusion: In routine clinical practice, regional anticoagulation with citrate is associated with significantly better circuit patency than heparin or epoprostenol.

KW - Citrate

KW - Acute kidney injury

KW - Continuous renal replacement therapy

KW - Anticoagulation

KW - CONTINUOUS VENOVENOUS HEMOFILTRATION

KW - CRITICALLY-ILL PATIENTS

KW - REGIONAL CITRATE

KW - HEPARIN ANTICOAGULATION

KW - SYSTEMIC HEPARIN

KW - LIVER-FAILURE

KW - HEMODIALYSIS

KW - EFFICACY

U2 - 10.1159/000355550

DO - 10.1159/000355550

M3 - Article

SN - 1660-2110

VL - 124

SP - 119

EP - 123

JO - NEPHRON CLINICAL PRACTICE

JF - NEPHRON CLINICAL PRACTICE

IS - 1-2

ER -