Revised algorithm for heparin anticoagulation during continuous renal replacement therapy

Premature clotting of the circuit is the most common reason for unplanned interruptions in renal replacement therapy (RRT) and discrepancies between the prescribed and delivered dose of RRT [1]. The recent guideline from the Kidney Disease Improving Global Outcomes (KDIGO) working group recommended citrate as the first-line anticoagulant for continuous renal replacement therapy (CRRT) [2]. For patients with contraindications to citrate, either unfractionated or low molecular weight heparin was recommended. Worldwide, unfractionated heparin is the most commonly used anticoagulant to maintain circuit patency [1]. The potential risks including bleeding and heparininduced thrombocytopenia are well known. In 2010, we designed an algorithm to enable the nursing staff to manage heparin during CRRT effectively and safely [3]. In response to new knowledge and changes in clinical practice, we have revised the algorithm (Fig. 1). The main principles of the algorithm are maintained as follows: