Continuous kidney replacement therapy in critically ill children: heparin vs citrate

Continuous kidney replacement therapy (CKRT) is currently the most frequent approach used in pediatric intensive care units (PICU) to treat children with acute kidney injury (AKI), fluid overload, electrolytes-acid base disorders, multiorgan dysfunction (MOD), inborn errors of metabolism, acute liver failure, sepsis, toxic ingestions, and drugs removal. 1 Preventing the deposition of fibrin and clots in the filters during CKRT in children is a significant challenge. These events progressively reduce the surface available for diffusion and convection, decrease the clearance of solutes, and lead to filter clotting, interrupting therapies and causing blood losses that require blood transfusions. Very few large pediatric studies have been done comparing how the most common anticoagulants used in CKRT affect the clinical outcome of critically ill children. In the current issue of Pediatric Research , Atis et al. reported their experience treating 131 critically ill children on CKRT with systemic heparin or regional citrate anticoagulation (RCA) in a tertiary PICU located in Istanbul. 2 Here, we will review the advantages and disadvantages of the two anticoagulant strategies and discuss key points relevant to the study of Atis et al.