Citrate Anticoagulation for Continuous Renal Replacement Therapy in Critically Ill Patients: Success and Limits

Incidence and outcome of citrate accumulation in critically ill patients undergoing continuous renal replacement therapy with regional citrate anticoagulation

Citrate anticoagulation for continuous renal replacement therapy (CRRT) in patients with acute kidney injury admitted to the intensive care unit

Continuous forms of renal replacement therapy (CRRT) have become established as the treatment of choice for supporting critically ill patients with acute kidney injury. Typically, these patients have activation of the coagulation cascades, peripheral mononuclear cells and platelets, but also a reduction in natural anticoagulants, and are therefore prothrombotic. For continuous modes of renal re...

A practical citrate anticoagulation continuous venovenous hemodiafiltration protocol for metabolic control and high solute clearance.

Obstacles to the widespread use of continuous renal replacement therapy (CRRT) include the need for anticoagulation, customized solutions, and complex protocols that carry an attendant risk for error, raise cost, and increase pharmacy and nursing workload. However, high solute clearance using CRRT with an effluent rate of 35 ml/kg per h has also recently been associated with improved survival i...

Long-term continuous renal replacement therapy and anticoagulation with citrate in critically ill patients with severe liver dysfunction

BACKGROUND As of 2009, anticoagulation with citrate was standard practice in continuous renal replacement therapy (CRRT) for critically ill patients at the University Medical Centre of Saarland, Germany. Partial hepatic metabolism of citrate means accumulation may occur during CRRT in critically ill patients with impaired liver function. The aim of this study was to evaluate the actual influenc...

Citrate anticoagulation versus systemic heparinisation in continuous venovenous haemofiltration in critically ill patients with acute kidney injury: a multi-center randomized clinical trial

Introduction: Because of ongoing controversy, renal and vital outcomes are compared between systemically administered unfractionated heparin and regional anticoagulation with citrate-buffered replacement solution in predilution mode, during continuous venovenous haemofiltration (CVVH) in critically ill patients with acute kidney injury (AKI). Methods: In this multi-center randomized controlled ...