Skip to main content


Log in

Citrate vs. heparin for anticoagulation in continuous venovenous hemofiltration: a prospective randomized study

  • Original
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript



To compare the efficacy and safety of adjusted-dose unfractionated heparin with that of regional citrate anticoagulation in intensive care patients treated by continuous venovenous hemofiltration (CVVH).

Design and setting

Prospective, randomized, clinical trial in a 32-bed medical and surgical ICU in a university teaching hospital.


ICU patients with acute renal failure requiring continuous renal replacement therapy, without cirrhosis, severe coagulopathy, or known sensitivity to heparin.


Before the first CVVH run patients were randomized to receive anticoagulation with heparin or trisodium citrate. Patients eligible for another CVVH run received the other study medication in a cross-over fashion until the fourth circuit.

Measurements and results

Forty-nine circuits (hemofilters) were analyzed: 23 with heparin and 26 with citrate. The median lifetime of hemofilters was 70 h (interquartile range 44–140) with citrate anticoagulation and 40 h (17–48) with heparin (p=0.0007). One major bleeding occurred during heparin anticoagulation and one metabolic alkalosis (pH=7.60) was noted with citrate after a protocol violation. Transfusion rates (units of red cells per day of CVVH) were, respectively, 0.2 (0.0–0.4) with citrate and 1.0 (0.0–2.0) with heparin (p=0.0008).


Regional citrate anticoagulation seems superior to heparin for the filter lifetime and transfusion requirements in ICU patients treated by continuous renal replacement therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others


  1. Ward DM, Mehta RL (1993) Extracorporeal management of acute renal failure patients at high risk of bleeding. Kidney Int 4:S237–S244

    Google Scholar 

  2. Reeves JH, Cumming AR, Gallagher L, O’Brien JL, Santamaria JD (1999) A controlled trial of low-molecular-weight heparin (dalteparin) versus unfractionated heparin as anticoagulant during continuous venovenous hemodialysis with filtration. Crit Care Med 27:2224–2228

    Article  CAS  Google Scholar 

  3. Fiaccadori E, Maggiore U, Rotelli C, Minari M, Melfa L, Cappe G, Cabassi A (2002) Continuous haemofiltration in acute renal failure with prostacyclin as the sole anti-haemostatic agent. Intensive Care Med 28:586–593

    Article  Google Scholar 

  4. Ohtake Y, Hirasawa H, Sugai T, Oda S, Shiga H, Matsuda K, Kitamura N (1991) Nafamostat mesylate as anticoagulant in continuous hemofiltration and continuous hemodiafiltration. Contrib Nephrol 93:215–217

    Article  CAS  Google Scholar 

  5. Tan HK, Baldwin I, Bellomo R (2000) Continuous veno-venous hemofiltration without anticoagulation in high-risk patients. Intensive Care Med 26:1652–1657

    Article  CAS  Google Scholar 

  6. Uchino S, Fealy N, Baldwin I, Morimatsu H, Bellomo R (2003) Continuous is not continuous: the incidence and impact of circuit “down-time” on uraemic control during continuous veno-venous haemofiltration. Intensive Care Med 29:575–578

    Article  Google Scholar 

  7. Cutts MW, Thomas AN, Kishen R (2000) Transfusion requirements during continuous veno-venous haemofiltration: the importance of filter life. Intensive Care Med 26:1694–1697

    Article  CAS  Google Scholar 

  8. Palsson R, Niles JL (1999) Regional citrate anticoagulation in continuous venovenous hemofiltration in critically ill patients with a high risk of bleeding. Kidney Int 55:1991–1997

    Article  CAS  Google Scholar 

  9. Kutsogiannis DJ, Mayers I, Chin WD, Gibney RT (2000) Regional citrate anticoagulation in continuous venovenous hemodiafiltration. Am J Kidney Dis 35:802–811

    Article  CAS  Google Scholar 

  10. Ronco C, Bellomo R, Homel P, Brendolan A, Dan M, Piccinni P, La Greca G (2000) Effects of different doses in continuous veno-venous haemofiltration on outcomes of acute renal failure: a prospective randomised trial. Lancet 356:26–30

    Article  CAS  Google Scholar 

  11. Mehta RL, McDonald BR, Aguilar MM, Ward DM (1990) Regional citrate anticoagulation for continuous arteriovenous hemodialysis in critically ill patients. Kidney Int 38:976–981

    Article  CAS  Google Scholar 

  12. Gabutti L, Marone C, Colucci G, Duchini F, Schonholzer C (2002) Citrate anticoagulation in continuous venovenous hemodiafiltration: a metabolic challenge. Intensive Care Med 28:1419–1425

    Article  Google Scholar 

  13. Tolwani AJ, Campbell RC, Schenk MB, Allon M, Warnock DG (2001) Simplified citrate anticoagulation for continuous renal replacement therapy. Kidney Int 60:370–374

    Article  CAS  Google Scholar 

  14. Le Gall JR, Lemeshow S, Saulnier F (1993) A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA 270:2957–2963

    Article  Google Scholar 

  15. Le Gall JR, Klar J, Lemeshow S, Saulnier F, Alberti C, Artigas A, Teres D (1996) The Logistic Organ Dysfunction system. A new way to assess organ dysfunction in the intensive care unit. ICU Scoring Group. JAMA 276:802–810

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Mehran Monchi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Monchi, M., Berghmans, D., Ledoux, D. et al. Citrate vs. heparin for anticoagulation in continuous venovenous hemofiltration: a prospective randomized study. Intensive Care Med 30, 260–265 (2004).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: