Citrate Anticoagulation in Continuous Renal Replacement Therapy: Multicenter PICU Study of Filter-Related Outcomes

被引：0

作者：

Kihtir, Hasan S. ^{[1
]}

Duyu, Muhterem ^{[2
]}

Mementoglu, Mehmet E. ^{[3
]}

Tolunay, Ilknur ^{[4
]}

Kendirli, Tanil ^{[5
]}

Ekinci, Faruk ^{[6
]}

Botan, Edin ^{[7
]}

Ongun, Ebru A. ^{[1
]}

Asik, Ayse ^{[2
]}

Gun, Emrah ^{[4
]}

Ucmak, Hacer ^{[5
]}

Sevketoglu, Esra ^{[3
]}

Yildizdas, Dincer ^{[6
]}

机构：

[1] Univ Hlth Sci, Antalya Training & Res Hosp, Dept Pediat Crit Care, Antalya, Turkiye

[2] Istanbul Medeniyet Univ, Goztepe Training & Res Hosp, Dept Pediat Crit Care, Istanbul, Turkiye

[3] Univ Hlth Sci, Bakirkoy Dr Sadi Konuk Res & Training Hosp, Dept Pediat Crit Care, Istanbul, Turkiye

[4] Univ Hlth Sci, Adana City Training & Res Hosp, Dept Pediat Crit Care, Adana, Turkiye

[5] Ankara Univ, Fac Med, Dept Pediat Crit Care, Ankara, Turkiye

[6] Cukurova Univ, Fac Med, Dept Pediat Crit Care, Adana, Turkiye

[7] Univ Hlth Sci, Van Training & Res Hosp, Dept Pediat Crit Care, Van, Turkiye

来源：

PEDIATRIC CRITICAL CARE MEDICINE | 2025年 / 26卷 / 02期

关键词：

anticoagulation; citrate; citrate-related complications; continuous renal replacement therapy; effective filter life; REGIONAL CITRATE; HEPARIN ANTICOAGULATION; HEMOFILTRATION; HEMODIALYSIS;

D O I：

10.1097/PCC.0000000000003661

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Objectives: To examine citrate anticoagulation in continuous renal replacement therapy (CRRT) in the PICU. Design: Post hoc analysis of a curated, multicenter dataset collected from January 1, 2022, to June 1, 2023. Setting: Seven PICUs in Turkey. Patients: PICU admissions in need of CRRT, 28 days to 18 years old. Interventions: None. Measurements and Main Results: In 128 filters used in 73 patients, the effective filter life (EFL) restricted to 72 hours was a median (interquartile range [IQR]) of 40.5 hours (IQR, 21-58 hr); total EFL was a median of 59 hours (IQR, 28-89 hr). Analysis of the receiver operating characteristic curve for initial citrate infusion dose (CID) and whether EFL reached 72 hours identified a cutoff level for initial CID of greater than 2.64 mmol citrate per liter of patient blood flow (mmol/L-bf). As expected, the two filter groups categorized by initial CID (>= 2.7 vs. < 2.7 mmol/L-bf) showed filters in children receiving higher initial dosing had longer total EFL (72 hr [IQR, 48-104 hr] vs. 38.5 hr [IQR, 18-84 hr]; p = 0.03). We failed to identify an association between CRRT for over 24 or 48 hours and greater odds (odds ratio [OR], 95% CI) of citrate accumulation (OR, 2.23; 95% CI, 0.82-6.13; p = 0.118 or OR, 1.78; 95% CI, 0.84-3.8; p = 0.134, respectively). However, we cannot exclude up to 6.1- or 3.8-fold odds of citrate accumulation; of note, CRRT over 72 hours was associated with greater odds of citrate accumulation (OR, 2.17; 95% CI, 1.01-4.68; p = 0.04). Citrate lock syndrome occurred in eight of 128 (6.3%; 95% CI, 3-11.4%) filters, and resolved without termination of CRRT. On multivariable analysis, a higher patient initial lactate concentration was associated with an 18% (95% CI, 7-30%) greater hazard of developing citrate accumulation. Conclusions: Citrate anticoagulation for CRRT is an option for children. Choosing an initial CID greater than or equal to 2.7 mmol/L-bf provides longer EFL but with the associated potential of citrate accumulation. Further studies are needed on initial CID and duration of EFL.

引用

页码：e216 / e226

页数：11

共 21 条

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