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Anticoagulation, delivered dose and outcomes in CRRT : The program to improve care in acute renal disease ( PICARD )
Author(s) -
ClaureDel Granado Rolando,
Macedo Etienne,
Soroko Sharon,
Kim YeonWon,
Chertow Glenn M.,
Himmelfarb Jonathan,
Ikizler T. Alp,
Paganini Emil P.,
Mehta Ravindra L.
Publication year - 2014
Publication title -
hemodialysis international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.658
H-Index - 47
eISSN - 1542-4758
pISSN - 1492-7535
DOI - 10.1111/hdi.12157
Subject(s) - medicine , interquartile range , heparin , renal replacement therapy , dialysis , odds ratio , hemodialysis , blood urea nitrogen , anesthesia , surgery , renal function
Delivered dialysis dose by continuous renal replacement therapies ( CRRT ) depends on circuit efficacy, which is influenced in part by the anticoagulation strategy. We evaluated the association of anticoagulation strategy used on solute clearance efficacy, circuit longevity, bleeding complications, and mortality. We analyzed data from 1740 sessions 24 h in length among 244 critically ill patients, with at least 48 h on CRRT . Regional citrate, heparin, or saline flushes was variably used to prevent or attenuate filter clotting. We calculated delivered dose using the standardized K t/ V urea . We monitored filter efficacy by calculating effluent urea nitrogen/blood urea nitrogen ratios. Filter longevity was significantly higher with citrate (median 48, interquartile range [ IQR ] 20.3–75.0 hours) than with heparin (5.9, IQR 8.5–27.0 hours) or no anticoagulation (17.5, IQR 9.5–32 hours, P < 0.0001). Delivered dose was highest in treatments where citrate was employed. Bleeding complications were similar across the three groups (P = 0.25). Compared with no anticoagulation, odds of death was higher with the heparin use (odds ratio [ OR ] 1.82, 95% confidence interval [ CI ] 1.02–3.32; P = 0.033), but not with citrate ( OR 1.02 95% CI 0.54–1.96; P = 0.53). Relative to heparin or no anticoagulation, the use of regional citrate for anticoagulation in CRRT was associated with significantly prolonged filter life and increased filter efficacy with respect to delivered dialysis dose. Rates of bleeding complications, transfusions, and mortality were similar across the three groups. While these and other data suggest that citrate anticoagulation may offer superior technical performance than heparin or no anticoagulation, adequately powered clinical trials comparing alternative anticoagulation strategies should be performed to evaluate overall safety and efficacy.