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

[11] Elhanan N., Skippen P., Nuthall G., Et al., Citrate anticoagulation in pediatric continuous venovenous hemofiltration, Pediatr Nephrol, 19, pp. 208-212, (2004)
[12] Persic V., Vajdic Trampuz B., Medved B., Et al., Regional citrate anticoagulation for continuous renal replacement therapy in newborns and infants: Focus on citrate accumulation, Artif Organs, 44, pp. 497-503, (2020)
[13] Liet J.-M., Baleine J., Demaret P., Et al., Semiautomated regional citrate anticoagulation for continuous kidney replacement therapy: An observational study in young children, Pediatr Crit Care Med, 23, pp. e429-e433, (2022)
[14] Ali F.N., Lane J.C., Hemofiltration circuit use beyond 72 hours in pediatric continuous renal replacement therapy, Int J Artif Organs, 35, pp. 139-143, (2012)
[15] Demirkol D., Karapinar B., Dursun O., Protocol for Continuous Renal Replacement Systems in Turkey Applied to Critically Ill Pediatric Patients, Turkish Society of Pediatric Emergency and Intensive Care Medicine, (2018)
[16] Chappell J.B., The oxidation of citrate, isocitrate and cis-aconitate by isolated mitochondria, Biochem J, 90, pp. 225-237, (1964)
[17] Tan J.-N., Haroon S.W.P., Mukhopadhyay A., Et al., Hyperlactatemia predicts citrate intolerance with regional citrate anticoagulation during continuous renal replacement therapy, J Intensive Care Med, 34, pp. 418-425, (2019)
[18] Kostekci Y.E., Kendirli T., Gun E., Et al., Evaluation of the efficacy and associated complications of regional citrate anticoagulation in neonates: Experience from a fourth level neonatal intensive care unit, Eur J Pediatr, 182, pp. 4897-4908, (2023)
[19] Khadzhynov D., Dahlinger A., Schelter C., Et al., Hyperlactatemia, lactate kinetics and prediction of citrate accumulation in critically ill patients undergoing continuous renal replacement therapy with regional citrate anticoagulation, Crit Care Med, 45, pp. e941-e946, (2017)
[20] Granado R.C.-D., Macedo E., Chertow G.M., Et al., Toward the optimal dose metric in continuous renal replacement therapy, Int J Artif Organs, 35, pp. 413-424, (2012)

← 1 2 3 →