| Citation: |
YANG Xueqing, DU Yong, CHEN Yahong, WU Jie. A scoping review in the application of regional citrate anticoagulation in patients undergoing continuous renal replacement therapy[J]. Journal of Clinical Medicine in Practice, 2024, 28(18): 142-148. DOI: 10.7619/jcmp.20242279
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To summarize and analyze the application of regional citrate anticoagulation (RCA) in patients undergoing continuous renal replacement therapy (CRRT) using a scoping review methodology.
Following the scoping review methodology, a systematic search was conducted in domestic and international databases, including CNKI, Wanfang Data, Cochrane Library, PubMed, and Embase for literature related to RCA in CRRT patients. The search was limited from the inception of the databases to August 10, 2023. Included studies were screened, summarized, and analyzed.
A total of 19 articles were included in this study, comprising 8 randomized controlled trials, 8 cohort studies, 2 case-control studies, and 1 cross-sectional survey. Anticoagulation methods for CRRT primarily included unfractionated heparin, low-molecular-weight heparin, thrombin inhibitors, nafamostat, and RCA. Compared to other anticoagulation methods, RCA exhibited advantages in lower bleeding risk and longer filter lifespan. Calcium ion monitoring during RCA application predominantly relies on the empirical trial-and-error approach. Major complications associated with RCA include citrate accumulation, acid-base imbalance, and ion metabolic disorders. For patients with high bleeding risk, hypercalcemia, and sepsis, RCA may confer greater benefits during CRRT.
RCA has gradually emerged as a preferred anticoagulation method for CRRT patients, offering advantages in extending filter lifespan and reducing bleeding risk. Future research should focus on calcium ion monitoring during RCA, enhancing safety and efficacy through targeted infusion systems, and further exploring the immunomodulatory effects of RCA and its mechanisms related to high inflammatory factor clearance rates.
| [1] |
BLANKESTIJN P J, VERNOOIJ R W M, HOCKHAM C, et al. Effect of hemodiafiltration or hemodialysis on mortality in kidney failure[J]. N Engl J Med, 2023, 389(8): 700-709. doi: 10.1056/NEJMoa2304820
|
| [2] |
PISTOLESI V, MORABITO S, POTA V, et al. Regional citrate anticoagulation (RCA) in critically ill patients undergoing renal replacement therapy (RRT): expert opinion from the SIAARTI-SIN joint commission[J]. J Anesth Analg Crit Care, 2023, 3(1): 7. doi: 10.1186/s44158-023-00091-w
|
| [3] |
AREPALLY G M, CINES D B. Pathogenesis of heparin-induced thrombocytopenia[J]. Transl Res, 2020, 225: 131-140. doi: 10.1016/j.trsl.2020.04.014
|
| [4] |
SCHNEIDER A G, JOURNOIS D, RIMMELÉ T. Complications of regional citrate anticoagulation: accumulation or overload?[J]. Crit Care, 2017, 21(1): 281. doi: 10.1186/s13054-017-1880-1
|
| [5] |
JAMES M, BOUCHARD J, HO J, et al. Canadian Society of Nephrology commentary on the 2012 KDIGO clinical practice guideline for acute kidney injury[J]. Am J Kidney Dis, 2013, 61(5): 673-685. doi: 10.1053/j.ajkd.2013.02.350
|
| [6] |
PALEVSKY P M, LIU K D, BROPHY P D, et al. KDOQI US commentary on the 2012 KDIGO clinical practice guideline for acute kidney injury[J]. Am J Kidney Dis, 2013, 61(5): 649-672. doi: 10.1053/j.ajkd.2013.02.349
|
| [7] |
GUO L T, HU Y D, ZENG Q J, et al. Factors affecting continuous renal replacement therapy duration in critically ill patients: a retrospective study[J]. Ther Apher Dial, 2023, 27(5): 898-908. doi: 10.1111/1744-9987.14024
|
| [8] |
LI P Y, ZHANG L, LIN L, et al. Effect of dynamic circuit pressures monitoring on the lifespan of extracorporeal circuit and the efficiency of solute removal during continuous renal replacement therapy[J]. Front Med, 2021, 8: 621921. doi: 10.3389/fmed.2021.621921
|
| [9] |
XUN K, QIU H, JIA M, et al. Treatment effect of regional sodium citrate anticoagulation in elderly patients with high-risk bleeding receiving continuous renal replacement therapy[J]. Clin Appl Thromb Hemost, 2021, 27: 1-6.
|
| [10] |
ZHAO L J, MA F, YU Y, et al. Regional citrate anticoagulation versus No-anticoagulation for continuous venovenous hemofiltration in acute severe hypernatremia patients with increased bleeding risk: a retrospective cohort study[J]. Blood Purif, 2020, 49(1/2): 44-54.
|
| [11] |
YU Y, BAI M, WEI Z, et al. Regional citrate anticoagulation versus low molecular weight heparin anticoagulation for continuous venovenous hemofiltration in patients with severe hypercalcemia: a retrospective cohort study[J]. Ren Fail, 2020, 42(1): 748-758. doi: 10.1080/0886022X.2020.1795879
|
| [12] |
YU Y, BAI M, MA F, et al. Regional citrate anticoagulation versus no-anticoagulation for continuous venovenous hemofiltration in patients with liver failure and increased bleeding risk: a retrospective case-control study[J]. PLoS One, 2020, 15(5): e0232516. doi: 10.1371/journal.pone.0232516
|
| [13] |
LI L, BAI M, YU Y, et al. Regional citrate anticoagulation vs no-anticoagulation for CRRT in hyperlactatemia patients with increased bleeding risk: a retrospective cohort study[J]. Semin Dial, 2020: 209-217.
|
| [14] |
WU B Y, ZHANG K Y, XU B, et al. Randomized controlled trial to evaluate regional citrate anticoagulation plus low-dose of dalteparin in continuous veno-venous hemofiltration[J]. Blood Purif, 2015, 39(4): 306-312. doi: 10.1159/000381662
|
| [15] |
RATANARAT R, PHAIRATWET P, KHANSOMPOP S, et al. Customized citrate anticoagulation versus No anticoagulant in continuous venovenous hemofiltration in critically ill patients with acute kidney injury: a prospective randomized controlled trial[J]. Blood Purif, 2023, 52(5): 455-463. doi: 10.1159/000529076
|
| [16] |
KAEWDOUNGTIEN P, TACHABOON S, KANGSUMRITH N, et al. Immunomodulation effect of regional citrate anticoagulation in acute kidney injury requiring renal replacement therapy[J]. Blood Purif, 2023, 52(5): 474-482. doi: 10.1159/000529350
|
| [17] |
SANSOM B, UDY A, SRIRAM S, et al. Circuit haemodynamics during non-citrate and regional citrate continuous renal replacement, and impact of blood flow on filter life[J]. Int J Artif Organs, 2022, 45(12): 988-996. doi: 10.1177/03913988221118585
|
| [18] |
GUTIERREZ-BERNAYS D, OSTWALD M, ANSTEY C, et al. Transition from heparin to citrate anticoagulation for continuous renal replacement therapy: safety, efficiency, and cost[J]. Ther Apher Dial, 2016, 20(1): 53-59. doi: 10.1111/1744-9987.12331
|
| [19] |
GOULD D W, DOIDGE J, SADIQUE M Z, et al. Erratum: Heparin versus citrate anticoagulation for continuous renal replacement therapy in intensive care: the RRAM observational study[J]. Health Technol Assess, 2022, 26(13): 85-86. doi: 10.3310/ZXHI9396-c202204
|
| [20] |
HUGUET M, RODAS L, BLASCO M, et al. Clinical impact of regional citrate anticoagulation in continuous renal replacement therapy in critically ill patients[J]. Int J Artif Organs, 2017, 40(12): 676-682. doi: 10.5301/ijao.5000633
|
| [21] |
TRESCHAN T A, SCHAEFER M S, GEIB J, et al. Argatroban versus Lepirudin in critically ill patients (ALicia): a randomized controlled trial[J]. Crit Care, 2014, 18(5): 588. doi: 10.1186/s13054-014-0588-8
|
| [22] |
SCHILDER L, NURMOHAMED S A, BOSCH F H, et al. Citrate anticoagulation versus systemic heparinisation in continuous venovenous hemofiltration in critically ill patients with acute kidney injury: a multi-center randomized clinical trial[J]. Crit Care, 2014, 18(4): 472. doi: 10.1186/s13054-014-0472-6
|
| [23] |
STUCKER F, PONTE B, TATAW J, et al. Efficacy and safety of citrate-based anticoagulation compared to heparin in patients with acute kidney injury requiring continuous renal replacement therapy: a randomized controlled trial[J]. Crit Care, 2015, 19(1): 91. doi: 10.1186/s13054-015-0822-z
|
| [24] |
MAKINO S, EGI M, KITA H, et al. Comparison of nafamostat mesilate and unfractionated heparin as anticoagulants during continuous renal replacement therapy[J]. Int J Artif Organs, 2016, 39(1): 16-21. doi: 10.5301/ijao.5000465
|
| [25] |
LEE Y K, LEE H W, CHOI K H, et al. Ability of nafamostat mesilate to prolong filter patency during continuous renal replacement therapy in patients at high risk of bleeding: a randomized controlled study[J]. PLoS One, 2014, 9(10): e108737. doi: 10.1371/journal.pone.0108737
|
| [26] |
TRAKARNVANICH T, SIRIVONGRANGSON P, TRONGTRAKUL K, et al. The effect of citrate in cardiovascular system and clot circuit in critically ill patients requiring continuous renal replacement therapy[J]. J Artif Organs, 2023, 26(1): 53-64. doi: 10.1007/s10047-022-01329-0
|
| [27] |
WEI T T, TANG X, ZHANG L, et al. Calcium-containing versus calcium-free replacement solution in regional citrate anticoagulation for continuous renal replacement therapy: a randomized controlled trial[J]. Chin Med J, 2022, 135(20): 2478-2487. doi: 10.1097/CM9.0000000000002369
|
| [28] |
SHENG R M, ZHAO W B, HUANG L H, et al. A target-oriented algorithm for maintaining serum calcium stability automatically in regional citrate anticoagulation[J]. Int J Artif Organs, 2021, 44(8): 551-559. doi: 10.1177/0391398820982620
|
| [29] |
ZHANG W, BAI M, YU Y, et al. Safety and efficacy of regional citrate anticoagulation for continuous renal replacement therapy in liver failure patients: a systematic review and meta-analysis[J]. Crit Care, 2019, 23(1): 22. doi: 10.1186/s13054-019-2317-9
|
| [30] |
HONORE P M, RIMMELÉ T. Total-to-ionized calcium ratio, taken alone, is no longer valid to diagnose citrate accumulation!What additional parameters should we consider to strengthen the utility of this ratio[J]. J Crit Care, 2020, 59: 172-175. doi: 10.1016/j.jcrc.2020.06.009
|
| [31] |
HONORE P M, MUGISHA A, DAVID C, et al. In severe liver disease, citrate can be used safely: the question remains-by which mechanism[J]. Crit Care, 2020, 24(1): 63. doi: 10.1186/s13054-020-2801-2
|
| [32] |
ANANTHARAMAN S, CHIONH C Y. Correcting hyponatremia by fluid sodium modulation in continuous renal replacement therapy with regional citrate anticoagulation[J]. Semin Dial, 2022, 35(2): 198-203. doi: 10.1111/sdi.13054
|
| [33] |
KHADZHYNOV D, DAHLINGER A, SCHELTER C, et al. Hyperlactatemia, lactate kinetics and prediction of citrate accumulation in critically ill patients undergoing continuous renal replacement therapy with regional citrate anticoagulation[J]. Crit Care Med, 2017, 45(9): e941-e946. doi: 10.1097/CCM.0000000000002501
|
| [34] |
MORABITO S, PISTOLESI V, TRITAPEPE L, et al. Regional citrate anticoagulation for RRTs in critically ill patients with AKI[J]. Clin J Am Soc Nephrol, 2014, 9(12): 2173-2188. doi: 10.2215/CJN.01280214
|
| [35] |
BIANCHI N A, ALTARELLI M, ECKERT P, et al. Complications of regional citrate anticoagulation for continuous renal replacement therapy: an observational study[J]. Blood Purif, 2020, 49(5): 567-575. doi: 10.1159/000506253
|
| [36] |
SIGWALT F, BOUTELEUX A, DAMBRICOURT F, et al. Clinical complications of continuous renal replacement therapy[J]. Contrib Nephrol, 2018, 194: 109-117.
|
| [37] |
JACOBS R, VERBRUGGHE W, DAMS K, et al. 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[J]. Life, 2023, 13(5): 1198. doi: 10.3390/life13051198
|
| [38] |
ZHOU Z F, LIU C, YANG Y Y, et al. Anticoagulation options for continuous renal replacement therapy in critically ill patients: a systematic review and network meta-analysis of randomized controlled trials[J]. Crit Care, 2023, 27(1): 222. doi: 10.1186/s13054-023-04519-1
|
| [39] |
MARGRAF A, LIU C, KVLLMAR M, et al. Analysis of leukocyte recruitment in continuous veno-venous hemofiltration with regional citrate vs. systemic heparin anticoagulation[J]. Cells, 2022, 11(11): 1815. doi: 10.3390/cells11111815
|
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