Regional Citrate Anticoagulation and Systemic Anticoagulation during Pediatric Continuous Renal Replacement Therapy: A Systematic Literature Review

Emanuele Buccione; Stefano Bambi; Laura Rasero; Lorenzo Tofani; Tessa Piazzini; Carlo Della Pelle; Khadija El Aoufy; Zaccaria Ricci; Stefano Romagnoli; Gianluca Villa

doi:10.3390/jcm11113121

Regional Citrate Anticoagulation and Systemic Anticoagulation during Pediatric Continuous Renal Replacement Therapy: A Systematic Literature Review

J Clin Med. 2022 May 31;11(11):3121. doi: 10.3390/jcm11113121.

Authors

Emanuele Buccione¹, Stefano Bambi², Laura Rasero², Lorenzo Tofani³, Tessa Piazzini³, Carlo Della Pelle⁴, Khadija El Aoufy⁵, Zaccaria Ricci^{3

6}, Stefano Romagnoli^{3

7}, Gianluca Villa^{3

7}

Affiliations

¹ Neonatal Intensive Care Unit, 65124 Pescara, Italy.
² Health Sciences Department, University of Florence, 50139 Florence, Italy.
³ Section of Anesthesiology, Intensive Care and Pain Medicine, Department of Health Sciences, University of Florence, 50139 Florence, Italy.
⁴ ASL02 Lanciano-Vasto-Chieti, 66100 Chieti, Italy.
⁵ Department of Experimental and Clinical Medicine, Azienda Ospedaliero Universitaria Careggi, 50134 Florence, Italy.
⁶ Pediatric Intensive Care Unit, Meyer Children's University Hospital, 50139 Florence, Italy.
⁷ Department of Anesthesia and Intensive Care, Azienda Ospedaliero Universitaria Careggi, 50139 Florence, Italy.

Abstract

Background: Clotting is a major drawback of continuous renal replacement therapy (CRRT) performed on critically ill pediatric patients. Although anticoagulation is recommended to prevent clotting, limited results are available on the effect of each pharmacological strategy in reducing filter clotting in pediatric CRRT. This study defines which anticoagulation strategy, between regional citrate anticoagulation (RCA) and systemic anticoagulation with heparin, is safer and more efficient in reducing clotting, patient mortality, and treatment complications during pediatric CRRT.

Methods: A systematic literature review was run considering papers published in English until December 2021 and describing patients' and treatments' complications in CRRT performed with heparin and RCA on patients aged less than 18 years.

Results: Eleven studies were considered, cumulatively comprising 1.706 CRRT sessions (62% with systemic anticoagulation and 38% with RCA). Studies have consistently identified RCA's superiority over systemic anticoagulation with heparin in prolonging circuit life. The pooled estimate (95% CI) of filter clotting risk showed that RCA is a protective factor for clotting risk (RR = 0.204).

Conclusions: RCA has a potential role in prolonging circuit life and seems superior to systemic anticoagulation with heparin in decreasing the risk of circuit clotting during CRRT performed in critically ill pediatric patients.

Keywords: anticoagulation methods; continuous renal replacement therapy; pediatric intensive care unit; regional anticoagulation; systemic anticoagulation.

Publication types

Review

Grants and funding

“Philip” and “Irene Toll Gage Foundation” has supported this study through research grants. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.