title: Anticoagulation strategies in venovenous hemodialysis in critically ill patients: a five-year evaluation in a surgical intensive care unit.
abstract: Renal failure is a common complication among critically ill patients. Timing, dosage, and mode of renal replacement (RRT) are under debate, but also anticoagulation strategies and vascular access interfere with dialysis success. We present a retrospective, five-year evaluation of patients requiring RRT on a multidisciplinary 50-bed surgical intensive care unit of a university hospital with special regard to anticoagulation strategies and vascular access. Anticoagulation was preferably performed with unfractionated heparin or regional citrate application (RAC). Bleeding and suspected HIT-II were most common causes for RAC. In CVVHD mode filter life span was significantly longer under RAC compared to heparin or other anticoagulation strategies (P=0.001). Femoral vascular access was associated with reduced filter life span (P=0.012), especially under heparin anticoagulation (P=0.015). Patients on RAC had higher rates of metabolic alkalosis (P=0.001), required more transfusions (P=0.045), and showed higher illness severity measured by SOFA scores (P=0.001). RRT with unfractionated heparin represented the most common anticoagulation strategy in this study population. However, patients with bleeding risk and severe organ dysfunction were more likely placed on RAC. Citrate provided longer filter life spans regardless of vascular access site. Attention has to be paid to metabolic disturbances.
authors.affiliation: Department of Anaesthesiology and Critical Care Medicine, Jena University Hospital, Erlanger Allee 101, 07747 Jena, Germany.
authors.forename: Christoph
authors.identifier: 0000-0002-1746-7024
authors.initials: C
authors.lastname: Sponholz
authors.affiliation: Department of Anaesthesiology and Critical Care Medicine, Jena University Hospital, Erlanger Allee 101, 07747 Jena, Germany.
authors.forename: Ole
authors.identifier: 0000-0003-4954-1820
authors.initials: O
authors.lastname: Bayer
authors.affiliation: Department of Anaesthesiology and Critical Care Medicine, Jena University Hospital, Erlanger Allee 101, 07747 Jena, Germany.
authors.forename: Björn
authors.initials: B
authors.lastname: Kabisch
authors.affiliation: Department of Anaesthesiology and Critical Care Medicine, Jena University Hospital, Erlanger Allee 101, 07747 Jena, Germany.
authors.forename: Karin
authors.initials: K
authors.lastname: Wurm
authors.affiliation: Department of Anaesthesiology and Critical Care Medicine, Jena University Hospital, Erlanger Allee 101, 07747 Jena, Germany.
authors.forename: Katharina
authors.initials: K
authors.lastname: Ebert
authors.affiliation: Department of Anaesthesiology and Critical Care Medicine, Jena University Hospital, Erlanger Allee 101, 07747 Jena, Germany ; Center for Sepsis Control and Care (CSCC), Integrated Research and Treatment Center, Jena University Hospital, 07747 Jena, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Bauer
authors.affiliation: Department of Anaesthesiology and Critical Care Medicine, Jena University Hospital, Erlanger Allee 101, 07747 Jena, Germany ; Center for Sepsis Control and Care (CSCC), Integrated Research and Treatment Center, Jena University Hospital, 07747 Jena, Germany.
authors.forename: Andreas
authors.identifier: 0000-0002-6499-4900
authors.initials: A
authors.lastname: Kortgen
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D001777:Blood Coagulation / Q000187:drug effects; D019343:Citric Acid / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D003422:Critical Care; D016638:Critical Illness; D005260:Female; D006493:Heparin / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D007362:Intensive Care Units; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D006435:Renal Dialysis / Q000009:adverse effects; D017582:Renal Replacement Therapy / Q000009:adverse effects
chemical_list: D000925:Anticoagulants; D019343:Citric Acid; D006493:Heparin