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NDT Plus Advance Access originally published online on September 25, 2009
NDT Plus 2009 2(6):439-447; doi:10.1093/ndtplus/sfp136
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© The Author 2009. Published by Oxford University Press [on behalf of ERA-EDTA]. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Citrate anticoagulation for continuous renal replacement therapy (CRRT) in patients with acute kidney injury admitted to the intensive care unit

Andrew Davenport1 and Ashita Tolwani2

1 UCL Center for Nephrology, Royal Free Campus, University College London Medical School, London, UK
2 Division of Nephrology, University of Alabama at Birmingham, Birmingham, AL, USA

Correspondence: Correspondence and offprint requests to: Andrew Davenport; E-mail: Andrew.davenport{at}royalfree.nhs.uk


  Abstract

Continuous forms of renal replacement therapy (CRRT) have become established as the treatment of choice for supporting critically ill patients with acute kidney injury. Typically, these patients have activation of the coagulation cascades, peripheral mononuclear cells and platelets, but also a reduction in natural anticoagulants, and are therefore prothrombotic. For continuous modes of renal replacement therapy to be effective, in terms of both effective solute clearance and also fluid removal, the extracorporeal circuits must operate continuously. Thus, preventing clotting in the CRRT circuit is a key goal to effective patient management. As these patients may also be at increased risk of bleeding, regional anticoagulation with citrate is increasing in popularity, particularly following the introduction of commercially available CRRT machines and fluids specifically designed for citrate anticoagulation. Although regional anticoagulation with citrate provides many advantages over other systemic anticoagulants, excess citrate may lead to both metabolic complications, ranging from acidosis to alkalosis and may also potentially expose patients to electrolyte disturbances due to hyper- and hyponatraemia and hyper- and hypocalcaemia.

Key Words: anticoagulation • citrate • CRRT • haemofiltration • haemodialysis

Received for publication March 5, 2009. Accepted for publication August 28, 2009.


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