Citrate Anticoagulation in Continuous Renal Replacement Therapy: Multicenter PICU Study of Filter-Related Outcomes.

• Tác giả: Ayse Asik, Edin Botan, Muhterem Duyu, Faruk Ekinci, Emrah Gun, Tanil Kendirli, Hasan S Kihtir, Mehmet E Mementoglu, Ebru A Ongun, Esra Sevketoglu, Ilknur Tolunay, Hacer Ucmak, Dincer Yildizdas
• Ngôn ngữ: eng
• Ký hiệu phân loại: 363.232 Patrol and surveillance
• Thông tin xuất bản: United States : Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies , 2025
• Bộ sưu tập: NCBI
• ID: 217480

Tóm tắt

 OBJECTIVES: To examine citrate anticoagulation in continuous renal replacement therapy (CRRT) in the PICU. DESIGN: Post hoc analysis of a curated, multicenter dataset collected from January 1, 2022, to June 1, 2023. SETTING: Seven PICUs in Turkey. PATIENTS: PICU admissions in need of CRRT, 28 days to 18 years old. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: In 128 filters used in 73 patients, the effective filter life (EFL) restricted to 72 hours was a median (interquartile range [IQR]) of 40.5 hours (IQR, 21-58 hr)
  total EFL was a median of 59 hours (IQR, 28-89 hr). Analysis of the receiver operating characteristic curve for initial citrate infusion dose (CID) and whether EFL reached 72 hours identified a cutoff level for initial CID of greater than 2.64 mmol citrate per liter of patient blood flow (mmol/L-bf). As expected, the two filter groups categorized by initial CID (≥ 2.7 vs. <
  2.7 mmol/L-bf) showed filters in children receiving higher initial dosing had longer total EFL (72 hr [IQR, 48-104 hr] vs. 38.5 hr [IQR, 18-84 hr]
  p = 0.03). We failed to identify an association between CRRT for over 24 or 48 hours and greater odds (odds ratio [OR], 95% CI) of citrate accumulation (OR, 2.23
  95% CI, 0.82-6.13
  p = 0.118 or OR, 1.78
  95% CI, 0.84-3.8
  p = 0.134, respectively). However, we cannot exclude up to 6.1- or 3.8-fold odds of citrate accumulation
  of note, CRRT over 72 hours was associated with greater odds of citrate accumulation (OR, 2.17
  95% CI, 1.01-4.68
  p = 0.04). Citrate lock syndrome occurred in eight of 128 (6.3%
  95% CI, 3-11.4%) filters, and resolved without termination of CRRT. On multivariable analysis, a higher patient initial lactate concentration was associated with an 18% (95% CI, 7-30%) greater hazard of developing citrate accumulation. CONCLUSIONS: Citrate anticoagulation for CRRT is an option for children. Choosing an initial CID greater than or equal to 2.7 mmol/L-bf provides longer EFL but with the associated potential of citrate accumulation. Further studies are needed on initial CID and duration of EFL.