CRRT and Citrate Anticoagulation in Critically Ill

Overview

Systemic heparinization is associated with a higher risk of bleeding when used to maintain patency of the extracorporealcircuit during continuous renal replacement therapy (CRRT) in critically ill patients. Regional anticoagulation can beachieved with citrate. Citrate is more frequently used in CRRT to provide regional anticoagulation of the in patients with thehigh risk of bleeding. The citrate is infused into the extracorporeal circuit before the hemofilter where chelates ionisedcalcium, thus inhibiting coagulation. The majority of the citrate and chelated calcium is filtrated and/or enters the dialysateand is removed from the circuit. Therefore, calcium must be infused to replace the loss of calcium. The remaining portionof citrate that is not dialyzed enters the patient’s systemic circulation and is metabolised in the liver. Previous studies implythat regional anticoagulation with citrate is an effective and safe form of anticoagulation for CRRT in critically ill patientswith a high risk of bleeding.

Key words:
citrate anticoagulation – critically ill – metabolism – CRRT – renal failure – bleeding