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Regional citrate anticoagulation (RCA) is the preferred first-line approach for continuous renal replacement therapy (CRRT), particularly in critically ill people.
Regional citrate anticoagulation lowers CRRT filter thrombosis risk compared to heparin in VA-ECMO patients without added safety concerns.
Regional citrate anticoagulation (RCA) is the preferred first-line approach for continuous renal replacement therapy (CRRT), particularly in critically ill people. Acute kidney injury (AKI) frequently complicates the course of patients on venoarterial extracorporeal membrane oxygenation (VA-ECMO), making CRRT a common requirement in intensive care settings.
However, the role of RCA in VA-ECMO remains debated owing to concerns around metabolic complications and limited real-world evidence. This study explored whether RCA offers superior safety and efficacy when compared to unfractionated heparin (UFH) in this high-risk population.
Adult patients receiving simultaneous VA-ECMO and CRRT were evaluated. The key outcome was CRRT filter thrombosis (circuit clotting leading to unplanned interruption). Secondary outcomes were coagulation parameters, filter lifespan, bleeding risk, transfusion requirements, and metabolic complications. Statistical analysis incorporated competing risk models with appropriate adjustments, ensuring robust and reliable clinical insights.
In this multicenter retrospective study, the analysis of CRRT sessions revealed that RCA substantially reduced the likelihood of filter thrombosis when compared to unfractionated heparin. While filter lifespan remained similar between groups, RCA illustrated clear superiority in maintaining circuit patency. Importantly, RCA did not increase bleeding events, transfusion burden, or severe metabolic complications, reinforcing its safety in critically ill VA-ECMO patients.
RCA emerged as a safe, effective, and clinically advantageous alternative to heparin in CRRT for patients on VA-ECMO. By lowering filter thrombosis risk without increasing bleeding or metabolic complications, RCA offers a compelling strategy to optimize CRRT performance and improve critical care outcomes in AKI.
Annals of Intensive Care
Comparison between regional citrate anticoagulation and systemic heparin anticoagulation in patients undergoing continuous renal replacement therapy and venoarterial extracorporeal membrane oxygenation: A retrospective multicentric study
Axel Hirwe et al.
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