Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2022 May 31;11(11):3121.
doi: 10.3390/jcm11113121.

Regional Citrate Anticoagulation and Systemic Anticoagulation during Pediatric Continuous Renal Replacement Therapy: A Systematic Literature Review

Emanuele Buccione  1 , Stefano Bambi  2 , Laura Rasero  2 , Lorenzo Tofani  3 , Tessa Piazzini  3 , Carlo Della Pelle  4 , Khadija El Aoufy  5 , Zaccaria Ricci  3   6 , Stefano Romagnoli  3   7 , Gianluca Villa  3   7
Affiliations
Review

Regional Citrate Anticoagulation and Systemic Anticoagulation during Pediatric Continuous Renal Replacement Therapy: A Systematic Literature Review

Emanuele Buccione et al. J Clin Med. .

Abstract

Background: Clotting is a major drawback of continuous renal replacement therapy (CRRT) performed on critically ill pediatric patients. Although anticoagulation is recommended to prevent clotting, limited results are available on the effect of each pharmacological strategy in reducing filter clotting in pediatric CRRT. This study defines which anticoagulation strategy, between regional citrate anticoagulation (RCA) and systemic anticoagulation with heparin, is safer and more efficient in reducing clotting, patient mortality, and treatment complications during pediatric CRRT.

Methods: A systematic literature review was run considering papers published in English until December 2021 and describing patients' and treatments' complications in CRRT performed with heparin and RCA on patients aged less than 18 years.

Results: Eleven studies were considered, cumulatively comprising 1.706 CRRT sessions (62% with systemic anticoagulation and 38% with RCA). Studies have consistently identified RCA's superiority over systemic anticoagulation with heparin in prolonging circuit life. The pooled estimate (95% CI) of filter clotting risk showed that RCA is a protective factor for clotting risk (RR = 0.204).

Conclusions: RCA has a potential role in prolonging circuit life and seems superior to systemic anticoagulation with heparin in decreasing the risk of circuit clotting during CRRT performed in critically ill pediatric patients.

Keywords: anticoagulation methods; continuous renal replacement therapy; pediatric intensive care unit; regional anticoagulation; systemic anticoagulation.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flow chart. yo: years old; IHD: intermittent hemodialysis; PD: peritoneal dialysis; pCRRT: pediatric continuous renal replacement therapy; RCA: regional citrate anticoagulation.
Figure 2
Figure 2
Forest plot for clotting rate difference between regional citrate anticoagulation vs. heparin anticoagulation.
See this image and copyright information in PMC

References

    1. Kellum J.A. Diagnostic Criteria for Acute Kidney Injury. Crit. Care Clin. 2015;31:621–632. doi: 10.1016/j.ccc.2015.06.001. - DOI - PMC - PubMed
    1. Khwaja A. KDIGO Clinical Practice Guidelines for Acute Kidney Injury. Nephron. 2012;120:c179–c184. doi: 10.1159/000339789. - DOI - PubMed
    1. Fry A.C. Management of Acute Renal Failure. Postgrad. Med. J. 2006;82:106–116. doi: 10.1136/pgmj.2005.038588. - DOI - PMC - PubMed
    1. Blanco F.C., Ortega G., Qureshi F.G. Renal Replacement Therapy in Children. Semin. Pediatr. Surg. 2015;24:25–31. doi: 10.1053/j.sempedsurg.2014.11.006. - DOI - PubMed
    1. Symons J.M., Chua A.N., Somers M.J., Baum M.A., Bunchman T.E., Benfield M.R., Brophy P.D., Blowey D., Fortenberry J.D., Chand D., et al. Demographic Characteristics of Pediatric Continuous Renal Replacement Therapy: A Report of the Prospective Pediatric Continuous Renal Replacement Therapy Registry. Clin. J. Am. Soc. Nephrol. 2007;2:732–738. doi: 10.2215/CJN.03200906. - DOI - PubMed

LinkOut - more resources