Continuous renal replacement therapy in COVID-19—associated AKI: adding heparin to citrate to extend filter life—a retrospective cohort study

Abstract Background Coronavirus disease 2019 (COVID-19) may predispose patients to thrombotic events. The best anticoagulation strategy for continuous renal replacement therapy (CRRT) in such is still under debate. purpose of this study was evaluate the impact that different protocols have on filter clotting risk. Methods This a retrospective observational comparing two strategies (citrate only and citrate plus intravenous infusion unfractionated heparin) with acute kidney injury (AKI), associated or not COVID-19 (COV + AKI COV ? AKI, respectively), who were submitted CRRT. Filter risks compared among groups. Results Between January July 2020, 238 evaluated: 188 group 50 group. during first use occurred 111 (46.6%). Heparin conferred protection against (HR = 0.37, 95% CI 0.25–0.55), resulting longer survival. Bleeding events need blood transfusion similar between heparin strategies. In-hospital mortality higher than patients, although it received those did not. more common D-dimer levels above median (5990 ng/ml). In multivariate analysis, lower risk 0.28, 0.18–0.43), whereas an elevated level high hemoglobin found be factors circuit clotting. A diagnosis marginally increased 2.15, 0.99–4.68). Conclusions adding systemic standard regional prolong CRRT patency by reducing low complications.