Regional Citrate vs. Systemic Unfractionated Heparin Anticoagulation for Continuous Renal Replacement Therapy in Paediatric Patients: Systematic Review and Meta‐Analysis

The efficacy and safety of unfractionated heparin (UFH) and regional citrate anticoagulation (RCA) in continuous renal replacement therapy (CRRT) are subjects of controversy across paediatric patients. We conducted a search of the PubMed, Embase and Cochrane Library databases from inception to 2024. The Newcastle–Ottawa Scale was used to assess the quality of the included studies. Sensitivity analysis confirmed the stability of results; publication bias was investigated by Egger test. We conducted a search of the PubMed, Embase and Cochrane Library databases from inception to 2024, and 12 studies were included. Compared with UFH, RCA significantly prolonged circuit survival time (WMD 12.09, 95% CI: [4.48, 19.71], p = 0.002), reduced the risk of filter clotting (RR = 0.60, 95% CI: [0.42–0.85], p = 0.004) and bleeding (RR = 0.42, 95% CI: [0.23–0.79], p = 0.007). Although citrate anticoagulation was more likely to cause metabolic alkalosis (RR = 3.22, 95% CI: [1.34–7.75], p = 0.009) and hypocalcemia (RR = 2.92, 95% CI: [1.93–4.41], p < 0.001), metabolic complications were manageable and mild. Further subgroup analysis of paediatrics showed that, compared with children with an average weight > 10 kg, citrate anticoagulation significantly extended the circuit survival time of children with an average weight ≤ 10 kg ( p < 0.001). Sensitivity analysis confirmed that the results were generally robust. RCA could be the first choice for anticoagulation in paediatrics, especially for infants weighing ≤ 10 kg.