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Regional citrate anticoagulation for continuous renal replacement therapy

Kindgen-Milles, Detlef; Brandenburger, Timo; Dimski, Thomas

Current Opinion in Critical Care: December 2018 - Volume 24 - Issue 6 - p 450–454
doi: 10.1097/MCC.0000000000000547
RENAL SYSTEM: Edited by Thomas Rimmelé
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Purpose of review The delivery of an effective dialysis dose in continuous renal replacement therapy (CRRT) depends on adequate anticoagulation of the extracorporeal circuit. In most patients, either systemic heparin anticoagulation (SHA) or regional citrate anticoagulation (RCA) is used. This review will outline the basics and rationale of RCA and summarize data on safety and efficacy of both techniques.

Recent findings The basic principle of RCA is to reduce the level of ionized calcium in the extracorporeal circuit via infusion of citrate. This way, effective anticoagulation restricted to the extracorporeal circuit is achieved. SHA and RCA were compared in a variety of studies. RCA significantly prolonged filter lifetime, reduced bleeding complications and provided excellent control of uremia and acid-base status. RCA was also safe in the majority of patients with impaired liver function, whereas caution must be exerted in those with severe multiorgan failure and persistent hyperlactatemia.

Summary RCA per se is safe and effective for anticoagulation of CRRT. Compared to SHA, efficacy of anticoagulation is improved and adverse effects are reduced. RCA can be recommended as the anticoagulation mode of choice for CRRT in most ICU patients.

Department of Anesthesiology, University Hospital Duesseldorf, Heinrich-Heine University Duesseldorf, Duesseldorf, Germany

Correspondence to Detlef Kindgen-Milles, MD, Department of Anesthesiology, University Hospital Duesseldorf, Heinrich-Heine University Duesseldorf, Moorenstr. 5, D-40225 Duesseldorf, Germany. Tel: +49 211 810 7047; e-mail: kindgen-milles@med.uni-duesseldorf.de

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