Regional Citrate Anticoagulation for Continuous Renal Replacement Therapy in Newborns

Overview

Journal Front Pediatr

Specialty Pediatrics

Date 2023 Mar 27

PMID 36969287

Authors

Haixia Huang

Xing Deng

Ke Bai

Chengjun Liu

Feng Xu

Hongxing Dang

Affiliations

Soon will be listed here.

Abstract

Background: Regional citrate anticoagulant (RCA) is recommended as the preferred anticoagulant regimen for continuous renal replacement therapy (CRRT) in adults; however, it is rarely reported in neonates due to concerns associated with their immature liver. Few studies have reported on the use of RCA to evaluate the safety and efficacy of RCA-CRRT in neonates.

Method: In this retrospective observational study, we reviewed the clinical records of neonates who underwent RCA-CRRT at our pediatric intensive care unit between September 2015 to January 2021.

Results: A total of 23 neonates underwent 57 sessions of RCA-CRRT. Their mean age was 10.1 ± 6.9 days and mean weight was 3.0 ± 0.7 kg (range, 0.95-4 kg). The mean filter life was 31.54 ± 19.58 h (range, 3.3-72.5 h). Compared to pretreatment values, the total-to-ionized calcium ratio (T/iCa) on RCA-CRRT increased (2.00 ± 34 0.36 vs. 2.19 ± 0.40, = 0.056) as did the incidence of T/iCa levels >2.5 (11.4 vs. 14.3, = 0.477), albeit not significantly. Using a post-treatment T/iCa threshold of 2.5, we divided all the cases into citrate accumulation (CA) and non-CA (NCA) groups. Compared with the NCA group, the CA group had significantly higher body weight (3.64 ± 0.32 kg vs. 2.95 ± 0.41 kg, = 0.033) and significantly lower blood flow rate per body weight ml/kg/min (3.08 ± 0.08 vs. 4.07 ± 0.71, = 0.027); however, there was no significant difference between the two groups in terms of age, corrected gestational age, the PRISM-III score, and biochemical tests.

Conclusion: RCA-CRRT is safe and effective for neonates. After appropriate adjustments of the RCA-CRRT parameters, the incidence of CA was not higher in neonates than in children or adults, and CA was not found to be significantly correlated with age or corrected gestational age.

Citing Articles

Citrate anticoagulation and systemic heparin anticoagulation during continuous renal replacement therapy among critically-ill children.

Atis S, Duyu M, Karakaya Z, Yilmaz A Pediatr Res. 2024; 96(3):702-712.

PMID: 38555381 PMC: 11499251. DOI: 10.1038/s41390-024-03163-x.

Evaluation of the efficacy and associated complications of regional citrate anticoagulation in neonates: experience from a fourth level neonatal intensive care unit.

Kostekci Y, Kendirli T, Gun E, Ucmak H, Demirtas F, Havan M Eur J Pediatr. 2023; 182(11):4897-4908.

PMID: 37597047 DOI: 10.1007/s00431-023-05162-2.

References

Spinale J, Laskin B, Sondheimer N, Swartz S, Goldstein S . High-dose continuous renal replacement therapy for neonatal hyperammonemia. Pediatr Nephrol. 2013; 28(6):983-6. PMC: 3633740. DOI: 10.1007/s00467-013-2441-8. View

Kreuzer M, Bonzel K, Buscher R, Offner G, Ehrich J, Pape L . Regional citrate anticoagulation is safe in intermittent high-flux haemodialysis treatment of children and adolescents with an increased risk of bleeding. Nephrol Dial Transplant. 2010; 25(10):3337-42. DOI: 10.1093/ndt/gfq225. View

Diane Mok T, Tseng M, Chiang M, Lin J, Chu S, Hsu J . Renal replacement therapy in the neonatal intensive care unit. Pediatr Neonatol. 2018; 59(5):474-480. DOI: 10.1016/j.pedneo.2017.11.015. View

Sohn Y, Paik K, Cho H, Kim S, Park S, Kim E . Continuous renal replacement therapy in neonates weighing less than 3 kg. Korean J Pediatr. 2012; 55(8):286-92. PMC: 3433565. DOI: 10.3345/kjp.2012.55.8.286. View

Raina R, Bedoyan J, Lichter-Konecki U, Jouvet P, Picca S, Mew N . Consensus guidelines for management of hyperammonaemia in paediatric patients receiving continuous kidney replacement therapy. Nat Rev Nephrol. 2020; 16(8):471-482. PMC: 7366888. DOI: 10.1038/s41581-020-0267-8. View

Lameire N, Kellum J . Contrast-induced acute kidney injury and renal support for acute kidney injury: a KDIGO summary (Part 2). Crit Care. 2013; 17(1):205. PMC: 4056805. DOI: 10.1186/cc11455. View

Lee S, Cho H . Fluid overload and outcomes in neonates receiving continuous renal replacement therapy. Pediatr Nephrol. 2016; 31(11):2145-52. DOI: 10.1007/s00467-016-3363-z. View

Soltysiak J, Warzywoda A, Kocinski B, Ostalska-Nowicka D, Benedyk A, Silska-Dittmar M . Citrate anticoagulation for continuous renal replacement therapy in small children. Pediatr Nephrol. 2013; 29(3):469-75. PMC: 3913856. DOI: 10.1007/s00467-013-2690-6. View

Kim J, Lee Y, Cho H . Optimal Prescriptions of Continuous Renal Replacement Therapy in Neonates with Hyperammonemia. Blood Purif. 2018; 47(1-3):16-22. DOI: 10.1159/000492660. View

10.

Nishimi S, Sugawara H, Onodera C, Toya Y, Furukawa H, Konishi Y . Complications During Continuous Renal Replacement Therapy in Critically Ill Neonates. Blood Purif. 2019; 47 Suppl 2:74-80. DOI: 10.1159/000496654. View

11.

Levi M, Opal S . Coagulation abnormalities in critically ill patients. Crit Care. 2006; 10(4):222. PMC: 1750988. DOI: 10.1186/cc4975. View

12.

Godin M, Murray P, Mehta R . Clinical approach to the patient with AKI and sepsis. Semin Nephrol. 2015; 35(1):12-22. PMC: 5617729. DOI: 10.1016/j.semnephrol.2015.01.003. View

13.

Raymakers-Janssen P, Lilien M, van Kessel I, Veldhoen E, Wosten-van Asperen R, van Gestel J . Citrate versus heparin anticoagulation in continuous renal replacement therapy in small children. Pediatr Nephrol. 2017; 32(10):1971-1978. PMC: 5579151. DOI: 10.1007/s00467-017-3694-4. View

14.

Garzotto F, Vidal E, Ricci Z, Paglialonga F, Giordano M, Laforgia N . Continuous kidney replacement therapy in critically ill neonates and infants: a retrospective analysis of clinical results with a dedicated device. Pediatr Nephrol. 2020; 35(9):1699-1705. DOI: 10.1007/s00467-020-04562-y. View

15.

Persic V, Vajdic Trampuz B, Medved B, Pavcnik M, Ponikvar R, Gubensek J . Regional citrate anticoagulation for continuous renal replacement therapy in newborns and infants: Focus on citrate accumulation. Artif Organs. 2019; 44(5):497-503. DOI: 10.1111/aor.13619. View

16.

Cortina G, McRae R, Chiletti R, Butt W . The Effect of Patient- and Treatment-Related Factors on Circuit Lifespan During Continuous Renal Replacement Therapy in Critically Ill Children. Pediatr Crit Care Med. 2020; 21(6):578-585. DOI: 10.1097/PCC.0000000000002305. View

17.

Sik G, Demirbuga A, Annayev A, Citak A . Regional citrate versus systemic heparin anticoagulation for continuous renal replacement therapy in critically ill children. Int J Artif Organs. 2019; 43(4):234-241. DOI: 10.1177/0391398819893382. View

18.

Davis T, Neumayr T, Geile K, Doctor A, Hmeil P . Citrate anticoagulation during continuous renal replacement therapy in pediatric critical care. Pediatr Crit Care Med. 2014; 15(5):471-85. DOI: 10.1097/PCC.0000000000000148. View

19.

Sutherland S, Zappitelli M, Alexander S, Chua A, Brophy P, Bunchman T . Fluid overload and mortality in children receiving continuous renal replacement therapy: the prospective pediatric continuous renal replacement therapy registry. Am J Kidney Dis. 2010; 55(2):316-25. DOI: 10.1053/j.ajkd.2009.10.048. View

20.

Liet J, Allain-Launay E, Gaillard-Leroux B, Barriere F, Chenouard A, Dejode J . Regional citrate anticoagulation for pediatric CRRT using integrated citrate software and physiological sodium concentration solutions. Pediatr Nephrol. 2014; 29(9):1625-31. DOI: 10.1007/s00467-014-2770-2. View