Beyond the randomized clinical trial: Citrate for continuous renal replacement therapy in clinical practice
Beyond the randomized clinical trial: Citrate for continuous renal replacement therapy in clinical practice
Background: Premature circuit clotting is a major problem during continuous renal replacement therapy (CRRT). Six randomized controlled trials confirmed that regional anticoagulation with citrate is superior to heparin. Our objective was to compare circuit patency with citrate, heparin and epoprostenol in routine clinical practice. Methods: We retrospectively analysed data on circuit patency of all circuits used in a single centre between September 2008 and August 2009. We differentiated between premature filter clotting, elective discontinuation and waste. Results: 309 patients were treated with CRRT (n = 2,059 circuits). The mean age was 65.7; 63.8% were male. The methods to maintain circuit patency were unfractionated heparin (42.3%), epoprostenol (23.0%), citrate (14.7%), combinations of different anticoagulants (14.6%) and no anticoagulation (4.7%). Premature clotting was the most common reason for circuit discontinuation among circuits anticoagulated with heparin, epoprostenol or combinations of different anticoagulants (59-62%). Among circuits anticoagulated with citrate the main reason for discontinuation was elective (61%). Hazard regression analysis confirmed significantly better circuit survival with citrate. Changing from heparin to citrate decreased the risk of premature circuit clotting by 75.8%. Conclusion: In routine clinical practice, regional anticoagulation with citrate is associated with significantly better circuit patency than heparin or epoprostenol.
Tovey, L.
4680f504-ba2a-4f9f-a92d-72ae7b98ed69
Dickie, H.
fddccd18-38cb-43c4-86c3-54539b0da3b7
Gangi, S.
7938d4af-ed0c-4c8c-9894-8e09256febb0
Terblanche, M.
2312ce3f-dd59-4938-a495-7018e1f73407
Mckenzie, C.
ec344dee-5777-49c5-970e-6326e82c9f8c
Beale, R.
6d8232c7-2d67-4613-a228-9fd6ebceb551
Treacher, D.
6cc67982-27f3-481c-bd16-0d9b76e36233
Ostermann, M.
3aad45dd-7d86-40cf-80ee-d6401ebdace2
19 November 2013
Tovey, L.
4680f504-ba2a-4f9f-a92d-72ae7b98ed69
Dickie, H.
fddccd18-38cb-43c4-86c3-54539b0da3b7
Gangi, S.
7938d4af-ed0c-4c8c-9894-8e09256febb0
Terblanche, M.
2312ce3f-dd59-4938-a495-7018e1f73407
Mckenzie, C.
ec344dee-5777-49c5-970e-6326e82c9f8c
Beale, R.
6d8232c7-2d67-4613-a228-9fd6ebceb551
Treacher, D.
6cc67982-27f3-481c-bd16-0d9b76e36233
Ostermann, M.
3aad45dd-7d86-40cf-80ee-d6401ebdace2
Tovey, L., Dickie, H., Gangi, S., Terblanche, M., Mckenzie, C., Beale, R., Treacher, D. and Ostermann, M.
(2013)
Beyond the randomized clinical trial: Citrate for continuous renal replacement therapy in clinical practice.
Nephron - Clinical Practice.
(doi:10.1159/000355550).
Abstract
Background: Premature circuit clotting is a major problem during continuous renal replacement therapy (CRRT). Six randomized controlled trials confirmed that regional anticoagulation with citrate is superior to heparin. Our objective was to compare circuit patency with citrate, heparin and epoprostenol in routine clinical practice. Methods: We retrospectively analysed data on circuit patency of all circuits used in a single centre between September 2008 and August 2009. We differentiated between premature filter clotting, elective discontinuation and waste. Results: 309 patients were treated with CRRT (n = 2,059 circuits). The mean age was 65.7; 63.8% were male. The methods to maintain circuit patency were unfractionated heparin (42.3%), epoprostenol (23.0%), citrate (14.7%), combinations of different anticoagulants (14.6%) and no anticoagulation (4.7%). Premature clotting was the most common reason for circuit discontinuation among circuits anticoagulated with heparin, epoprostenol or combinations of different anticoagulants (59-62%). Among circuits anticoagulated with citrate the main reason for discontinuation was elective (61%). Hazard regression analysis confirmed significantly better circuit survival with citrate. Changing from heparin to citrate decreased the risk of premature circuit clotting by 75.8%. Conclusion: In routine clinical practice, regional anticoagulation with citrate is associated with significantly better circuit patency than heparin or epoprostenol.
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Accepted/In Press date: 23 August 2013
Published date: 19 November 2013
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Local EPrints ID: 479573
URI: http://eprints.soton.ac.uk/id/eprint/479573
PURE UUID: 15672c58-28af-4851-adb8-1670d143320a
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Date deposited: 26 Jul 2023 16:38
Last modified: 17 Mar 2024 04:23
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Author:
L. Tovey
Author:
H. Dickie
Author:
S. Gangi
Author:
M. Terblanche
Author:
C. Mckenzie
Author:
R. Beale
Author:
D. Treacher
Author:
M. Ostermann
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