[Citrate anticoagulation in acute renal replacement therapy : Method of choice].
BACKGROUND
Anticoagulation is prerequisite for efficient continuous renal replacement therapy (CRRT). Premature clotting of the extracorporeal system leads to therapy interruptions, is costly, and causes relevant blood losses.
Regional citrate anticoagulation (RCA) achieves reliable coagulation inhibition and is clearly superior to heparin with regard to filter survival time. Due to its mode of action, a bleeding risk can be excluded. RCA with the commercial machine solutions is safe and has been promoted as the new standard anticoagulant for CRRT. Bioincompatibility reactions like leukocyte degranulation and complement system activation are ameliorated under RCA.


CONCLUSIONS
An assumed survival advantage of RCA could not be confirmed. In case of severe liver insufficiency and lactic acidosis, RCA can lead to metabolic complications. Despite calcium supplementation, the calcium net balance of RCA is often negative. Long treatment durations can therefore cause secondary hyperparathyroidism and in extreme cases osteomalacia. RCA is also a valuable option in intermittent hemodialysis.
Klinik für Innere Medizin, St.-Antonius-Hospital Eschweiler, Dechant-Deckers-Str. 8, 52249, Eschweiler, Deutschland, dario.frank@sah-eschweiler.de.
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Frank
D058186:Acute Kidney Injury / Q000097:blood / Q000628:therapy*; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use*; D002118:Calcium / Q000097:blood; D019343:Citric Acid / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000097:blood / Q000139:chemically induced; D010018:Osteomalacia / Q000097:blood / Q000139:chemically induced; D017582:Renal Replacement Therapy / Q000379:methods*; D012307:Risk Factors
D000925:Anticoagulants; D019343:Citric Acid; D002118:Calcium