Comparison of heparin and citrate anticoagulation during continuous veno-venous haemodialysis (CVVHD) in critically ill children – prospective, crossover study


Authors: T. Zaoral 1;  M. Hladík 1;  J. Zapletalová 2
Authors‘ workplace: Dětská klinika, Oddělení dětské intenzivní resuscitační péče, Lékařská fakulta OU, Fakultní nemocnice Ostrava 1;  Ústav lékařské biofyziky, Lékařská fakulta, Fakultní nemocnice Olomouc 2
Published in: Anest. intenziv. Med., 26, 2015, č. 5, s. 270-278
Category: Intensive Care Medicine - Original Paper

Overview

Objective:
In continuous renal replacement therapy, heparin anticoagulation has been largely replaced with citrate anticoagulation to limit the risk of bleeding. In this prospective crossover trial, we compared the heparin and citrate effect on the circuit lifetimes during continuous veno-venous haemodialysis (CVVHD) in children.

Design:
Prospective, crossover trial.

Setting:
Paediatric intensive care unit, Department of Paediatrics, University Hospital.

Materials and methods:
From 2009 to 2014, 63 eligible children (age 89.24 ± 62.9 months, weight 30.37 ± 20.62 kg) received at least 24 hours of CVVHD. Each child received four CVVHD circuits with anticoagulants in the following order: heparin, citrate, heparin, citrate. Circuit life ended when the trans-membrane pressure was ≥ 250 mmHg for > 60 min.

Results:
The total mean circuit lifetime was 39.75 ± 10.73 h. Citrate had a significantly longer median circuit lifetime (41.0 h, CI: 37.6–44.4) than heparin (36.0 h, CI: 35.4–36.6; p < 0.0001). Mortality was 33.33%. Circuit lifetime was significantly correlated to patient age (r = 0.606), weight (r = 0.763), and blood flow rate (r = 0.697). Metabolic and electrolyte imbalances were readily resolved.

Conclusion:
We showed that citrate provided significantly longer circuit lifetimes than heparin for CVVHD in children. Citrate was found to be feasible and safe in children and infants in our study.

Keywords:
continuous venovenous hemodialysis – heparin – citrate – children


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Labels
Anaesthesiology, Resuscitation and Inten Intensive Care Medicine
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