Citrate Anticoagulation for Continuous Renal Replacement Therapy in Critically Ill Patients: Success and Limits
Open Access
- 1 January 2011
- journal article
- Published by Hindawi Limited in International Journal of Nephrology
- Vol. 2011, 1-5
- https://doi.org/10.4061/2011/748320
Abstract
Citrate anticoagulation has risen in interest so it is now a real alternative to heparin in the ICUs practice. Citrate provides a regional anticoagulation virtually restricted to extracorporeal circuit, where it acts by chelating ionized calcium. This issue is particularly true in patients ongoing CRRT, when the “continuous” systemic anticoagulation treatment is per se a relevant risk of bleeding. When compared with heparin most of studies with citrate reported a longer circuit survival, a lower rate of bleeding complications, and transfused packed red cell requirements. As anticoagulant for CRRT, the infusion of citrate is prolonged and it could potentially have some adverse effects. When citrate is metabolized to bicarbonate, metabolic alkalosis may occur, or for impaired metabolism citrate accumulation leads to acidosis. However, large studies with dedicated machines have indeed demonstrated that citrate anticoagulation is well tolerated, safe, and an easy to handle even in septic shock critically ill patients.Keywords
This publication has 31 references indexed in Scilit:
- A safe citrate anticoagulation protocol with variable treatment efficacy and excellent control of the acid–base status*Critical Care Medicine, 2009
- Citrate anticoagulation for continuous venovenous hemofiltration*Critical Care Medicine, 2009
- And the winner is: Regional citrate anticoagulation*Critical Care Medicine, 2009
- Citrate Plasma Levels in Patients Under Regional Anticoagulation in Continuous Venovenous HemofiltrationAmerican Journal of Kidney Diseases, 2006
- Citrate Kinetics in Patients Receiving Long-Term Hemodialysis TherapyAmerican Journal of Kidney Diseases, 2005
- Current Canadian Approaches to Dialysis for Acute Renal Failure in the ICUAmerican Journal of Nephrology, 2002
- Regional citrate anticoagulation in continuous venovenous hemofiltration in critically ill patients with a high risk of bleedingKidney International, 1999
- Regional citrate anticoagulation for continuous arteriovenous hemodialysis in critically ill patientsKidney International, 1990
- REGIONAL ANTICOAGULATION DURING HEMODIALYSIS USING CITRATEThe American Journal of the Medical Sciences, 1961
- über BlutwaschungKlinische Wochenschrift, 1928