title: Transition From Heparin to Citrate Anticoagulation for Continuous Renal Replacement Therapy: Safety, Efficiency, and Cost.
abstract: Regional citrate anticoagulation (RCA) for continuous renal replacement therapy (CRRT) has recently been recommended as first-line over heparin. Evidence suggests that RCA prolongs filter life and may reduce bleeding risk, but there is little research on the benefits to dialysis dose delivery or cost, or the effectiveness of transitioning to RCA first-line. The aim of the present study was to assess the effect on dialysis delivery, cost and safety when transitioning from systemic heparin to RCA for first-line anticoagulation for CRRT. A single-center, retrospective observational study was conducted from 2006 to 2012, during which a transition from heparin to a simplified RCA protocol occurred. Demographic and dialysis data, pathology results and costs were obtained. Data were analyzed for both heparin and RCA, and for before and after the transition. 166 patients had 992 dialysis days (heparin 334 vs. RCA 658); demographics were well matched; RCA used less filters per day (P = 0.03), had more days when prescribed dialysis was achieved (85% vs. 60%, P < 0.001), and less filter "down-time" per day (2.4 vs. 6.1 h, P = 0.02). RCA was estimated to cost AU$487 per day, compared to heparin at $479 per day. When the data were analyzed, comparing before and after the transition, these results remained statistically significant. There was no statistical difference in clinical safety events. Transition to first-line RCA was safe, provided more time on filter and consumed less filter circuits using a simple and user friendly protocol. The adjusted cost difference appears negligible.
authors.affiliation: Intensive Care Department, Sunshine Coast Hospital Health Service, Nambour, QLD, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Gutierrez-Bernays
authors.affiliation: Intensive Care Department, Sunshine Coast Hospital Health Service, Nambour, QLD, Australia.
authors.forename: Matthew
authors.initials: M
authors.lastname: Ostwald
authors.affiliation: Intensive Care Department, Sunshine Coast Hospital Health Service, Nambour, QLD, Australia.|Sunshine Coast Clinical School, The University of Queensland, Nambour, QLD, Australia.
authors.forename: Chris
authors.initials: C
authors.lastname: Anstey
authors.affiliation: Intensive Care Department, Sunshine Coast Hospital Health Service, Nambour, QLD, Australia.|Sunshine Coast Clinical School, The University of Queensland, Nambour, QLD, Australia.
authors.forename: Victoria
authors.initials: V
authors.lastname: Campbell
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects; D001315:Australia; D065096:Calcium Chelating Agents / Q000008:administration & dosage / Q000009:adverse effects; D019343:Citric Acid / Q000008:administration & dosage / Q000009:adverse effects; D003365:Costs and Cost Analysis; D004333:Drug Administration Routes; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced / Q000517:prevention & control; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D051436:Renal Insufficiency, Chronic / Q000191:economics / Q000628:therapy; D017582:Renal Replacement Therapy / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data; D012189:Retrospective Studies
chemical_list: D000925:Anticoagulants; D065096:Calcium Chelating Agents; D019343:Citric Acid; D006493:Heparin
keywords: Anticoagulation; Citrate; Continuous renal replacement therapy; Dialysis