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Regional citrate anticoagulation for continuous renal replacement therapy in children

Pediatric Nephrology volume 32, pages 703–711 (2017)Cite this article

An Erratum to this article was published on 09 January 2017

Abstract

Background

Anticoagulation of the continuous renal replacement therapy (CRRT) circuit is an important technical aspect of this medical procedure. Most studies evaluating the efficacy and safety of citrate use have been carried out in adults, and little evidence is available for the pediatric patient population. The aim of this study was to compare regional citrate anticoagulation versus systemic heparin anticoagulation in terms of the lifetime of hemofilters in a pediatric population receiving CRRT at a pediatric center in Bogota, Colombia.

Methods

This was an analytical, observational, retrospective cohort study in which we assessed the survival of 150 hemofilters (citrate group 80 hemofilters, heparin group 70 hemofilters) used in a total of 3442 hours of CCRT (citrate group 2248 h, heparin group 1194 h). Hemofilter survival was estimated beginning at placement and continuing until filter replacement due to clotting or high trans-membrane pressures.

Results

Hemofilter survival was higher in the citrate group than in the heparin group (72 vs. 18 h; p <0.0001). Bivariate analysis showed that the hemofilter coagulation risk was significantly increased when heparin was used, regardless of hemofilter size and pump flow (hazard ratio 3.70, standard error 0.82, 95% confidence interval 2.39–5.72; p <0.00001).

Conclusions

Regional citrate anticoagulation could be more effective than heparin systemic anticoagulation in terms of prolonging the hemofilter lifetime in patients with acute renal injury who require CRRT.

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Authors and Affiliations

  1. Division of Pediatric Nephrology, Department of Pediatrics, Fundación Cardioinfantil IC, Instituto de Cardiologia, Bogota, Cundinamarca, Colombia

    Mayerly Prada Rico, Luz Stella González Chaparro, Ricardo Gastelbondo Amaya & Ana Maria Quintero Gómez

  2. Division of Pediatric Critical Care, Department of Pediatrics, Fundación Cardio-infantil IC, Universidad de la Sabana, Campus Universitario del Puente del Común, Km 7 Autopista Norte de Bogota, Chía, Cundinamarca, Colombia

    Jaime Fernández Sarmiento, Hernando Mulett Hoyos & Daniel Tibaduiza

  3. Division of Pediatric Gastroenterology, Pediatric Gastroenterology, Hepatology and Nutrition Unit, GASTRONUTRIPED, Bogota, Cundinamarca, Colombia

    Ana María Rojas Velasquez

Authors
  1. Mayerly Prada Rico
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  2. Jaime Fernández Sarmiento
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  3. Ana María Rojas Velasquez
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  4. Luz Stella González Chaparro
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  5. Ricardo Gastelbondo Amaya
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  8. Ana Maria Quintero Gómez
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Corresponding author

Correspondence to Jaime Fernández Sarmiento.

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Conflict of interest

The authors declare there exists no conflict of interest.

Ethics statement

This study was approved by the institutional ethics committee.

Additional information

The original version of this article was revised to correct the rendering of the name of the author Jaime Fernández Sarmiento.

An erratum to this article is available at http://dx.doi.org/10.1007/s00467-016-3568-1.

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Rico, M.P., Fernández Sarmiento, J., Rojas Velasquez, A.M. et al. Regional citrate anticoagulation for continuous renal replacement therapy in children. Pediatr Nephrol 32, 703–711 (2017). https://doi.org/10.1007/s00467-016-3544-9

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  • DOI: https://doi.org/10.1007/s00467-016-3544-9

Keywords

  • Anticoagulation
  • Citrate
  • Heparin
  • Continuous renal replacement therapy
  • Dialysis
  • Children