Comparison of the Efficacy and Safety of Regional Citrate versus Systemic Heparin Anticoagulation on Continuous Renal Replacement Therapy with Critically Ill Patients: A Retrospective Study

Öz

The efficacy of continuous renal replacement therapy (CRRT) depends on effective anticoagulation to maintain the extracorporeal circuit. CRRT is crucial in critically ill patients with multiple organ failure. The choice of regional citrate anticoagulation (RCA) and systemic unfractionated heparin anticoagulation (SHA) used as anticoagulation in CRRT is still controversial because of the citrate accumulation, the unpredictability of citrate’s in-vivo efficacy and the bleeding complications of SHA. The purpose of this study was to evaluate the effect and safety of RCA versus SHA on CRRT by minimizing the independent variables, was conducted by comparing the first dialysis of the same patients using both methods at different times. Between September 2018 and September 2019, 102 patients who underwent CRRT were examined and 11 patients whose anticoagulation method was changed due to various reasons were included in the study. The filter life time (95% CI: [1.25-53.29]; p=0,042) and ultrafiltration rate (95% CI: [9.43-64.20]; p=0,013) is statistically higher in RCA group. However no significant differences were observed via initial and final values of electrolyte, urea, creatinine and, pH in two groups (p>0,05). RCA is a safe and effective anticoagulation method that can be used especially in critically ill patients undergoing CRRT who may have bleeding complications.

Anahtar Kelimeler

• Regional citrate anticoaggulation
• systemic heparin anticoaggulation
• continuous renal replacement therapy
• critically illness.

Kritik Hastalarda Sürekli Renal Replasman Tedavisinde Kullanılan Rejyonel Sitrat ve Sistemik Heparin Antikoagülasyonunun Etkinliği ve Güvenliğinin Karşılaştırılması: Retrospektif Çalışma

Öz

Sürekli renal replasman tedavisinin (SRRT) etkinliği ekstrakorporeal devrenin sürdürülebilmesi için etkin bir antikoagülasyona bağlıdır. Çoklu organ yetmezliği olan kritik hastalarda SRRT hayat kurtarıcıdır. SRRT’de antikoagülasyon olarak kullanılan rejyonel sitrat antikoagülasyonu (RSA) ve sistemik heparin antikoagülasyonu (SHA) tercihi sitratın akümülasyonunun tehlikeleri in-vivo etkinliğinin öngörülememesi ve SHA’nın kanama komplikasyonları nedeniyle halen tartışmalıdır. Bağımsız değişkenleri en aza indirerek RSA'ya karşı SHA'nın SRRT üzerindeki etkisini ve güvenliğini değerlendirmek için yapılan bu çalışma; aynı hastaların her iki koagülasyon yönteminin farklı zamanlarda kullanıldığı ilk diyalizlerine ait parametreler karşılaştırarak gerçekleştirildi. 2018 Eylül ve 2019 Eylül ayları arasında SRRT uygulanan 102 hasta incelenmiş çeşitli nedenlerden dolayı antikoagülasyon yöntemi değiştirilen 11 hasta çalışmaya dahil edilmiştir. Çalışmamızda RSA yöntemi SRRT’de kullanıldığına SHA yöntemi kullanılmasına göre filtre ömrünün (%95 CI: [1.25-53.29]; p= 0,042) ve ultrafiltrasyon hızının (%95 CI: [9.43-64.20]; p=0,013) istatistiksel olarak anlamlı bir şekilde arttığı gözlendi. Bununla birlikte grupların başlangıç ve bitiş elektrolit, üre,kreatinin ve pH değerleri arasında anlamlı fark tespit edilmedi (p>0,05). RSA özellikle kanama komplikasyonu olabilecek SRRT yapılacak kritik hastalarda SHA yerine kullanılabilecek güvenli ve etkili antikoagülasyon yöntemidir.

Anahtar Kelimeler

• Rejyonel sitrat antikoagülasyonu
• sürekli renal replasman tedavisi
• sistemik unfraksiyone heparin antikoagülasyonu
• kritik hasta.
• Regional citrate anticoaggulation
• systemic heparin anticoaggulation
• continuous renal replacement therapy
• critically illness.

Kaynakça

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