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Intensive Care Medicine

, Volume 41, Issue 12, pp 2098–2110 | Cite as

Citrate versus heparin anticoagulation for continuous renal replacement therapy: an updated meta-analysis of RCTs

  • Ming Bai
  • Meilan Zhou
  • Lijie He
  • Feng Ma
  • Yangping Li
  • Yan Yu
  • Pengbo Wang
  • Li Li
  • Rui Jing
  • Lijuan Zhao
  • Shiren Sun
Systematic Review

Abstract

Purpose

The purpose of this study was to evaluate the effect and safety of citrate versus heparin anticoagulation for continuous renal replacement therapy (CRRT) in critically ill patients by performing a meta-analysis of updated evidence.

Methods

Medline, Embase, and Cochrane databases were searched for eligible studies, and manual searches were also performed to identify additional trials. Randomized controlled trials (RCTs) assessing the effect of citrate versus heparin anticoagulation for CRRT were considered eligible for inclusion.

Results

Eleven RCTs with 992 patients and 1998 circuits met the inclusion criteria. Heparin was regionally delivered in two trials and systemically delivered in nine trials. Citrate for CRRT significantly reduced the risk of circuit loss compared to regional (HR 0.52, 95 % CI 0.35–0.77, P = 0.001) and systemic (HR 0.76, 95 % CI 0.59–0.98, P = 0.04) heparin. Citrate also reduced the incidence of filter failure (RR 0.70, 95 % CI 0.50–0.98, P = 0.04). The citrate group had a significantly lower bleeding risk than the systemic heparin group (RR 0.36, 95 % CI 0.21–0.60, P < 0.001) and a similar bleeding risk to the regional heparin group (RR 0.34, 95 % CI 0.01–8.24, P = 0.51). The incidences of heparin-induced thrombocytopenia (HIT) and hypocalcemia were increased in the heparin and citrate groups, respectively. No significant survival difference was observed between the groups.

Conclusions

Given the lower risk of circuit loss, filter failure, bleeding, and HIT, regional citrate should be considered a better anticoagulation method than heparin for CRRT in critically ill patients without any contraindication.

Keywords

Continuous renal replacement therapy Citrate Heparin Anticoagulation Randomized controlled trial Meta-analysis 

Notes

Acknowledgments

There was no financial support for this work.

Compliance with ethical standards

Conflicts of interest

The authors have no potential conflicts of interest to disclose.

Supplementary material

134_2015_4099_MOESM1_ESM.tif (10.2 mb)
Supplementary Figure 1. Funnel plots of comparisons: citrate versus heparin. Outcomes: a circuit loss and b bleeding. (TIFF 10456 kb)
134_2015_4099_MOESM2_ESM.docx (17 kb)
Supplementary material 2 (DOCX 17 kb)
134_2015_4099_MOESM3_ESM.docx (13 kb)
Supplementary material 3 (DOCX 13 kb)
134_2015_4099_MOESM4_ESM.docx (15 kb)
Supplementary material 4 (DOCX 14 kb)

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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2015

Authors and Affiliations

  • Ming Bai
    • 1
  • Meilan Zhou
    • 1
  • Lijie He
    • 1
  • Feng Ma
    • 1
  • Yangping Li
    • 1
  • Yan Yu
    • 1
  • Pengbo Wang
    • 1
  • Li Li
    • 1
  • Rui Jing
    • 1
  • Lijuan Zhao
    • 1
  • Shiren Sun
    • 1
  1. 1.Department of Nephrology, Xijing HospitalThe Fourth Military Medical UniversityXi’anChina

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