摘要

Background: Anticoagulation of the extracorporeal circuit is required in continuous renal replacement therapy (CRRT). Heparin is the classic choice for anticoagulation, although it may increase the risk of bleeding. Regional citrate anticoagulation reduces the risk of bleeding, but may cause hypocalcemia and metabolic disturbances. Study Design: Systematic review and meta-analysis of randomized controlled trials (RCTs). Setting & Population: Patients admitted to the intensive care unit with acute kidney injury that required CRRT. Selection Criteria for Studies: RCTs regardless of publication status or language. Intervention: Regional citrate versus heparin anticoagulation in CRRT. Outcomes: The primary outcomes were circuit survival time, the occurrence of major bleeding defined as a site of gross bleeding with a decrease in blood pressure or requiring transfusion of 2 or more units of red blood cells, metabolic alkalosis, hypocalcemia, and thrombocytopenia. The secondary outcome was cost. Results: 6 RCTs with 488 patients were identified. Citrate anticoagulation was associated with a significant decrease in bleeding (RR, 0.34; 95% CI, 0.17-0.65). Circuit survival time, the incidence of metabolic alkalosis, and thrombocytopenia showed no significant difference between groups. Hypocalcemia was more common in patients receiving citrate, although no clinical adverse event was reported in the included studies. Limitations: Significant heterogeneity in the primary outcome. Conclusion: The efficacy of citrate and heparin anticoagulation for CRRT was similar. However, citrate anticoagulation decreased the risk of bleeding with no significant increase in the incidence of metabolic alkalosis. We recommend citrate as an anticoagulation agent in patients who require CRRT but are at high risk of bleeding.
原文英語
頁(從 - 到)810-818
頁數9
期刊American Journal of Kidney Diseases
59
發行號6
DOIs
出版狀態已發佈 - 六月 2012

指紋

Renal Replacement Therapy
Citric Acid
Heparin
Meta-Analysis
Randomized Controlled Trials
Hemorrhage
Alkalosis
Hypocalcemia
Thrombocytopenia
Survival
Incidence
Acute Kidney Injury
Anticoagulants
Patient Selection
Intensive Care Units
Publications
Language
Erythrocytes
Blood Pressure
Costs and Cost Analysis

ASJC Scopus subject areas

  • Nephrology

引用此文

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title = "Regional citrate versus heparin anticoagulation for continuous renal replacement therapy: A meta-analysis of randomized controlled trials",
abstract = "Background: Anticoagulation of the extracorporeal circuit is required in continuous renal replacement therapy (CRRT). Heparin is the classic choice for anticoagulation, although it may increase the risk of bleeding. Regional citrate anticoagulation reduces the risk of bleeding, but may cause hypocalcemia and metabolic disturbances. Study Design: Systematic review and meta-analysis of randomized controlled trials (RCTs). Setting & Population: Patients admitted to the intensive care unit with acute kidney injury that required CRRT. Selection Criteria for Studies: RCTs regardless of publication status or language. Intervention: Regional citrate versus heparin anticoagulation in CRRT. Outcomes: The primary outcomes were circuit survival time, the occurrence of major bleeding defined as a site of gross bleeding with a decrease in blood pressure or requiring transfusion of 2 or more units of red blood cells, metabolic alkalosis, hypocalcemia, and thrombocytopenia. The secondary outcome was cost. Results: 6 RCTs with 488 patients were identified. Citrate anticoagulation was associated with a significant decrease in bleeding (RR, 0.34; 95{\%} CI, 0.17-0.65). Circuit survival time, the incidence of metabolic alkalosis, and thrombocytopenia showed no significant difference between groups. Hypocalcemia was more common in patients receiving citrate, although no clinical adverse event was reported in the included studies. Limitations: Significant heterogeneity in the primary outcome. Conclusion: The efficacy of citrate and heparin anticoagulation for CRRT was similar. However, citrate anticoagulation decreased the risk of bleeding with no significant increase in the incidence of metabolic alkalosis. We recommend citrate as an anticoagulation agent in patients who require CRRT but are at high risk of bleeding.",
keywords = "anticoagulation, Citrate, continuous renal replacement therapy, heparin, meta-analysis",
author = "Wu, {Mei Yi} and Hsu, {Yung Ho} and Bai, {Chyi Huey} and Lin, {Yuh Feng} and Wu, {Chih Hsiung} and Tam, {Ka Wai}",
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T1 - Regional citrate versus heparin anticoagulation for continuous renal replacement therapy

T2 - A meta-analysis of randomized controlled trials

AU - Wu, Mei Yi

AU - Hsu, Yung Ho

AU - Bai, Chyi Huey

AU - Lin, Yuh Feng

AU - Wu, Chih Hsiung

AU - Tam, Ka Wai

PY - 2012/6

Y1 - 2012/6

N2 - Background: Anticoagulation of the extracorporeal circuit is required in continuous renal replacement therapy (CRRT). Heparin is the classic choice for anticoagulation, although it may increase the risk of bleeding. Regional citrate anticoagulation reduces the risk of bleeding, but may cause hypocalcemia and metabolic disturbances. Study Design: Systematic review and meta-analysis of randomized controlled trials (RCTs). Setting & Population: Patients admitted to the intensive care unit with acute kidney injury that required CRRT. Selection Criteria for Studies: RCTs regardless of publication status or language. Intervention: Regional citrate versus heparin anticoagulation in CRRT. Outcomes: The primary outcomes were circuit survival time, the occurrence of major bleeding defined as a site of gross bleeding with a decrease in blood pressure or requiring transfusion of 2 or more units of red blood cells, metabolic alkalosis, hypocalcemia, and thrombocytopenia. The secondary outcome was cost. Results: 6 RCTs with 488 patients were identified. Citrate anticoagulation was associated with a significant decrease in bleeding (RR, 0.34; 95% CI, 0.17-0.65). Circuit survival time, the incidence of metabolic alkalosis, and thrombocytopenia showed no significant difference between groups. Hypocalcemia was more common in patients receiving citrate, although no clinical adverse event was reported in the included studies. Limitations: Significant heterogeneity in the primary outcome. Conclusion: The efficacy of citrate and heparin anticoagulation for CRRT was similar. However, citrate anticoagulation decreased the risk of bleeding with no significant increase in the incidence of metabolic alkalosis. We recommend citrate as an anticoagulation agent in patients who require CRRT but are at high risk of bleeding.

AB - Background: Anticoagulation of the extracorporeal circuit is required in continuous renal replacement therapy (CRRT). Heparin is the classic choice for anticoagulation, although it may increase the risk of bleeding. Regional citrate anticoagulation reduces the risk of bleeding, but may cause hypocalcemia and metabolic disturbances. Study Design: Systematic review and meta-analysis of randomized controlled trials (RCTs). Setting & Population: Patients admitted to the intensive care unit with acute kidney injury that required CRRT. Selection Criteria for Studies: RCTs regardless of publication status or language. Intervention: Regional citrate versus heparin anticoagulation in CRRT. Outcomes: The primary outcomes were circuit survival time, the occurrence of major bleeding defined as a site of gross bleeding with a decrease in blood pressure or requiring transfusion of 2 or more units of red blood cells, metabolic alkalosis, hypocalcemia, and thrombocytopenia. The secondary outcome was cost. Results: 6 RCTs with 488 patients were identified. Citrate anticoagulation was associated with a significant decrease in bleeding (RR, 0.34; 95% CI, 0.17-0.65). Circuit survival time, the incidence of metabolic alkalosis, and thrombocytopenia showed no significant difference between groups. Hypocalcemia was more common in patients receiving citrate, although no clinical adverse event was reported in the included studies. Limitations: Significant heterogeneity in the primary outcome. Conclusion: The efficacy of citrate and heparin anticoagulation for CRRT was similar. However, citrate anticoagulation decreased the risk of bleeding with no significant increase in the incidence of metabolic alkalosis. We recommend citrate as an anticoagulation agent in patients who require CRRT but are at high risk of bleeding.

KW - anticoagulation

KW - Citrate

KW - continuous renal replacement therapy

KW - heparin

KW - meta-analysis

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