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NDT Plus Advance Access originally published online on December 9, 2008
NDT Plus 2009 2(1):11-19; doi:10.1093/ndtplus/sfn184
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© The Author [2008]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Role of citrate and other methods of anticoagulation in patients with severe liver failure requiring continuous renal replacement therapy

Josée Bouchard and François Madore

Division of Nephrology, Department of Medicine, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montreal, Quebec, Canada

Correspondence: Correspondence and offprint requests to: François Madore, Research Center, Hôpital du Sacré-Coeur de Montréal, 5400 Blvd. Gouin west, Montreal, QC H4J 1C5, Canada. Tel: +1-514-338-2222; Ext. 2491; Fax: +1-514-338-2694; E-mail: f.madore{at}umontreal.ca


  Abstract

Anticoagulation is required during continuous renal replacement therapy to prevent filter clotting and optimize filter performance. However, anticoagulation may also be associated with serious bleeding complications. Patients with liver failure often suffer from underlying coagulopathy and are especially prone to anticoagulation complications. The aim of this review is to present the unique features of patients with hepatic injury in terms of anticoagulation disorders and to analyze data on safety and efficacy of the different anticoagulation methods for liver failure patients undergoing continuous renal replacement therapy.

Key Words: anticoagulation • citrate • continuous renal replacement therapy • liver failure

Received for publication February 27, 2008. Accepted for publication November 3, 2008.


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