Citrate anticoagulation in CRRT showed no significant difference in mortality compared to unfractionated heparin across 4 trials, but reduced bleeding risk and increased hypocalcemia.
Meta-Analysis
Does citrate anticoagulation improve mortality or reduce bleeding compared to unfractionated heparin in adult patients with acute kidney injury prescribed continuous renal replacement therapy?
Citrate anticoagulation in continuous renal replacement therapy reduces bleeding risk compared to unfractionated heparin without affecting mortality, though it increases the risk of hypocalcemia.
BACKGROUND: Unfractionated heparin is the most commonly used anticoagulant in continuous renal replacement therapy (CRRT), but it can increase the risk of bleeding. Citrate is a promising substitute. Our study was to assess the efficacy and safety of citrate versus unfractionated heparin in CRRT. METHODS: We searched the MEDLINE, the EMBASE, the Cochrane Central Register of Controlled Trials, and the China National Knowledge Infrastructure Database until up to November 2011 for randomized controlled trials comparing citrate with unfractionated heparin in adult patients with acute kidney injury prescribed CRRT. The primary outcome was mortality and the secondary outcomes included circuit survival, control of uremia, risk of bleeding, transfusion rates, acid-base statuses, and disturbance of sodium and calcium homeostasis. RESULTS: Four trials met the inclusion criteria. Meta-analysis found no significant difference between two anticoagulants on mortality. Less bleeding and more hypocalcemic episodes were with citrate. Citrate was superior or comparable to unfractionated heparin in circuit life. CONCLUSIONS: Citrate anticoagulation in CRRT seems to be superior in reducing bleeding risk and with a longer or similar circuit life, although there is more metabolic derangement. Mortality superiority has not been approved.
Liao et al. (Fri,) conducted a meta-analysis in Acute kidney injury prescribed CRRT. Citrate vs. Unfractionated heparin was evaluated on Mortality. Citrate anticoagulation in CRRT showed no significant difference in mortality compared to unfractionated heparin across 4 trials, but reduced bleeding risk and increased hypocalcemia.