The University of Southampton
University of Southampton Institutional Repository

Evaluating the safety and efficacy of regional citrate compared to systemic heparin as anticoagulation for continuous renal replacement therapy in critically ill patients: A service evaluation following a change in practice

Evaluating the safety and efficacy of regional citrate compared to systemic heparin as anticoagulation for continuous renal replacement therapy in critically ill patients: A service evaluation following a change in practice
Evaluating the safety and efficacy of regional citrate compared to systemic heparin as anticoagulation for continuous renal replacement therapy in critically ill patients: A service evaluation following a change in practice
Following the implementation of citrate anticoagulation for continuous renal replacement therapy, we evaluate its first year of use and compare it to the previously used heparin, to assess whether our patients benefit from the recently reported advantages of citrate. We retrospectively analysed 2 years of data to compare the safety and efficacy of citrate versus heparin. The results have shown that 43 patients received continuous renal replacement therapy with heparin, 37 patients with citrate. We found no significant difference in metabolic control of pH, urea and creatinine after 72 h. Filters anticoagulated with citrate had significantly longer median lifespan (33 h vs 17 h; p = 0.001), shorter downtime (0 h vs 5 h; p = 0.015) and less filter sets per patient day (0.37 vs 0.67; p = 0.002). Filters anticoagulated with heparin were commonly interrupted due to clotting (50% vs 16.4%), whereas filters anticoagulated with citrate were often stopped electively (53.4% vs 24.6%). Patients on heparin filters had significantly higher APPTs, some at potentially dangerous levels (>180 s), whilst patients on citrate filters had significantly higher levels of bicarbonate. Therefore, we conclude that citrate is superior in terms of safety and efficacy, with longer filter lifespan. It has become our first line anticoagulant for continuous renal replacement therapy.
184-192
Borg, Roberta
b93a841a-fcb2-45cc-b7d0-e64d2db7a929
Ugboma, Debra
7fa9da18-fd36-4ba9-bdf1-0fa2c4224395
Walker, Dawn-Marie
5d4c78b7-4411-493e-8844-b64efc72a1e8
Partridge, Richard
c6f15f96-5891-4221-8d02-bb100ca3178b
Borg, Roberta
b93a841a-fcb2-45cc-b7d0-e64d2db7a929
Ugboma, Debra
7fa9da18-fd36-4ba9-bdf1-0fa2c4224395
Walker, Dawn-Marie
5d4c78b7-4411-493e-8844-b64efc72a1e8
Partridge, Richard
c6f15f96-5891-4221-8d02-bb100ca3178b

Borg, Roberta, Ugboma, Debra, Walker, Dawn-Marie and Partridge, Richard (2017) Evaluating the safety and efficacy of regional citrate compared to systemic heparin as anticoagulation for continuous renal replacement therapy in critically ill patients: A service evaluation following a change in practice. Journal of the Intensive Care Society, 18 (3), 184-192. (doi:10.1177/1751143717695835).

Record type: Article

Abstract

Following the implementation of citrate anticoagulation for continuous renal replacement therapy, we evaluate its first year of use and compare it to the previously used heparin, to assess whether our patients benefit from the recently reported advantages of citrate. We retrospectively analysed 2 years of data to compare the safety and efficacy of citrate versus heparin. The results have shown that 43 patients received continuous renal replacement therapy with heparin, 37 patients with citrate. We found no significant difference in metabolic control of pH, urea and creatinine after 72 h. Filters anticoagulated with citrate had significantly longer median lifespan (33 h vs 17 h; p = 0.001), shorter downtime (0 h vs 5 h; p = 0.015) and less filter sets per patient day (0.37 vs 0.67; p = 0.002). Filters anticoagulated with heparin were commonly interrupted due to clotting (50% vs 16.4%), whereas filters anticoagulated with citrate were often stopped electively (53.4% vs 24.6%). Patients on heparin filters had significantly higher APPTs, some at potentially dangerous levels (>180 s), whilst patients on citrate filters had significantly higher levels of bicarbonate. Therefore, we conclude that citrate is superior in terms of safety and efficacy, with longer filter lifespan. It has become our first line anticoagulant for continuous renal replacement therapy.

Text
Evaluating the safety and efficacy of regional citrate compared to systemic heparin - Accepted Manuscript
Download (325kB)

More information

Accepted/In Press date: 1 March 2017
e-pub ahead of print date: 14 March 2017
Published date: 14 March 2017
Organisations: Bio-Behavioural Sciences, Researcher Development

Identifiers

Local EPrints ID: 410534
URI: https://eprints.soton.ac.uk/id/eprint/410534
PURE UUID: 564d8177-3850-480b-8289-99f35c19cb5a
ORCID for Dawn-Marie Walker: ORCID iD orcid.org/0000-0003-2135-1363

Catalogue record

Date deposited: 09 Jun 2017 09:03
Last modified: 15 Jul 2019 18:13

Export record

Altmetrics

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of https://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×