Regional Citrate Anticoagulation in Continuous Renal Replacement Therapy: Is Metabolic Fear the Enemy of Logic? A Systematic Review and Meta-Analysis of Randomised Controlled Trials.
anticoagulation
citrate
continuous renal replacement therapy
filter lifespan
heparin
metabolic complications
Journal
Life (Basel, Switzerland)
ISSN: 2075-1729
Titre abrégé: Life (Basel)
Pays: Switzerland
ID NLM: 101580444
Informations de publication
Date de publication:
17 May 2023
17 May 2023
Historique:
received:
13
03
2023
revised:
31
03
2023
accepted:
05
04
2023
medline:
27
5
2023
pubmed:
27
5
2023
entrez:
27
5
2023
Statut:
epublish
Résumé
Anticoagulation is recommended to maintain the patency of the circuit in continuous renal replacement therapy (CRRT). However, anticoagulation-associated complications can occur. We performed a systematic review and meta-analysis to compare the efficacy and safety of citrate anticoagulation to heparin anticoagulation in critically ill patients treated with CRRT. Randomised controlled trials (RCTs) evaluating the safety and efficacy of citrate anticoagulation and heparin in CRRT were included. Articles not describing the incidence of metabolic and/or electrolyte disturbances induced by the anticoagulation strategy were excluded. The PubMed, Embase, and MEDLINE electronic databases were searched. The last search was performed on 18 February 2022. Twelve articles comprising 1592 patients met the inclusion criteria. There was no significant difference between the groups in the development of metabolic alkalosis (RR = 1.46; (95% CI (0.52-4.11); regional citrate anticoagulation is a safe anticoagulant for critically ill patients who require CRRT, as no significant differences were found in metabolic complications between the groups. Additionally, citrate has a lower risk of bleeding and circuit loss than heparin.
Sections du résumé
BACKGROUND
BACKGROUND
Anticoagulation is recommended to maintain the patency of the circuit in continuous renal replacement therapy (CRRT). However, anticoagulation-associated complications can occur. We performed a systematic review and meta-analysis to compare the efficacy and safety of citrate anticoagulation to heparin anticoagulation in critically ill patients treated with CRRT.
METHODS
METHODS
Randomised controlled trials (RCTs) evaluating the safety and efficacy of citrate anticoagulation and heparin in CRRT were included. Articles not describing the incidence of metabolic and/or electrolyte disturbances induced by the anticoagulation strategy were excluded. The PubMed, Embase, and MEDLINE electronic databases were searched. The last search was performed on 18 February 2022.
RESULTS
RESULTS
Twelve articles comprising 1592 patients met the inclusion criteria. There was no significant difference between the groups in the development of metabolic alkalosis (RR = 1.46; (95% CI (0.52-4.11);
CONCLUSION
CONCLUSIONS
regional citrate anticoagulation is a safe anticoagulant for critically ill patients who require CRRT, as no significant differences were found in metabolic complications between the groups. Additionally, citrate has a lower risk of bleeding and circuit loss than heparin.
Identifiants
pubmed: 37240843
pii: life13051198
doi: 10.3390/life13051198
pmc: PMC10221969
pii:
doi:
Types de publication
Journal Article
Review
Langues
eng
Références
Semin Dial. 2021 Nov;34(6):416-422
pubmed: 33684244
Crit Care. 2016 May 13;20(1):144
pubmed: 27176622
JAMA. 2020 Oct 27;324(16):1629-1639
pubmed: 33095849
Nat Rev Nephrol. 2018 Oct;14(10):607-625
pubmed: 30135570
Chest. 2004 Sep;126(3 Suppl):188S-203S
pubmed: 15383472
J Intensive Care Med. 2019 May;34(5):418-425
pubmed: 28372501
Crit Care. 2006;10(2):R67
pubmed: 16646985
Clin J Am Soc Nephrol. 2006 Jan;1(1):79-87
pubmed: 17699194
Kidney Int. 2012 Jul;82(1):9-18
pubmed: 21814173
Kidney Int. 2005 Jun;67(6):2361-7
pubmed: 15882280
Kidney Int. 1990 Oct;38(4):728-35
pubmed: 2232510
Cochrane Database Syst Rev. 2020 Mar 13;3:CD012467
pubmed: 32164041
Crit Care Resusc. 2014 Jun;16(2):131-7
pubmed: 24888284
Crit Care Med. 2015 Aug;43(8):1622-9
pubmed: 25853591
Crit Care. 2007;11(4):218
pubmed: 17634148
Contrib Nephrol. 2018;194:109-117
pubmed: 29597222
Semin Dial. 2010 Nov-Dec;23(6):581-5
pubmed: 21166876
NDT Plus. 2009 Dec;2(6):439-47
pubmed: 25949376
Intensive Care Med. 2006 Feb;32(2):188-202
pubmed: 16453140
J Clin Epidemiol. 2011 Apr;64(4):380-2
pubmed: 21185693
BMC Nephrol. 2016 Aug 26;17(1):119
pubmed: 27562561
Int J Artif Organs. 2007 Apr;30(4):301-7
pubmed: 17520566
Nephrol Dial Transplant. 2006 Mar;21(3):690-6
pubmed: 16326743
Crit Care Explor. 2021 May 12;3(5):e0399
pubmed: 34079944
Contrib Nephrol. 2004;144:228-38
pubmed: 15264412
Int J Artif Organs. 2008 Mar;31(3):228-36
pubmed: 18373316
J Intensive Care Med. 2013 May-Jun;28(3):166-77
pubmed: 21841146
Nephron Clin Pract. 2012;120(4):c179-84
pubmed: 22890468
Nephron Clin Pract. 2004;97(4):c131-6
pubmed: 15331942
N Engl J Med. 1995 May 18;332(20):1330-5
pubmed: 7715641
Int J Artif Organs. 2005 Mar;28(3):222-8
pubmed: 15818544
Mil Med Res. 2021 Jul 3;8(1):41
pubmed: 34217371
Crit Care Med. 2008 Feb;36(2):610-7
pubmed: 18216610
Clin J Am Soc Nephrol. 2014 Dec 5;9(12):2173-88
pubmed: 24993448
Contrib Nephrol. 2007;156:178-84
pubmed: 17464125
Crit Care Med. 2001 Apr;29(4):748-52
pubmed: 11373461
Intensive Care Med. 2004 Feb;30(2):260-265
pubmed: 14600809
J Crit Care. 2014 Apr;29(2):265-71
pubmed: 24360392
Intensive Care Med. 2017 Jun;43(6):750-763
pubmed: 27730284
BMJ. 2019 Aug 28;366:l4898
pubmed: 31462531
Nephrol Dial Transplant. 2011 Jan;26(1):232-9
pubmed: 20876598
J Clin Epidemiol. 2021 Jun;134:178-189
pubmed: 33789819
Semin Dial. 2009 Mar-Apr;22(2):141-5
pubmed: 19426417
Crit Care. 2015 Sep 29;19:349
pubmed: 26415638
Am J Kidney Dis. 1996 Apr;27(4):519-24
pubmed: 8678062
Crit Care. 2015 Mar 18;19:91
pubmed: 25881975
Ther Apher Dial. 2022 Dec;26(6):1086-1097
pubmed: 35385216
Crit Care. 2014 Aug 16;18(4):472
pubmed: 25128022
Nephrol Dial Transplant. 2011 Dec;26(12):3882-8
pubmed: 21385861
Crit Care Med. 2003 Oct;31(10):2450-5
pubmed: 14530750
Crit Care. 2017 Nov 19;21(1):281
pubmed: 29151020
Crit Care. 2011 Jan 24;15(1):202
pubmed: 21345279
Kidney Int. 2020 Aug;98(2):294-309
pubmed: 32709292
Clin Chem Lab Med. 2006;44(8):962-6
pubmed: 16879061
Blood Purif. 2015;39(4):306-12
pubmed: 26022434
J Nephrol. 2015 Apr;28(2):151-64
pubmed: 25585821
Klin Wochenschr. 1977 Nov 15;55(22):1121-2
pubmed: 592681
J Nephrol. 2007 Sep-Oct;20(5):602-8
pubmed: 17918147
Biom J. 2020 Jan;62(1):69-98
pubmed: 31553488
Crit Care Med. 2009 Feb;37(2):545-52
pubmed: 19114912