Clinical review: Anticoagulation for continuous renal replacement therapy - heparin or citrate?

Table 1 Randomized clinical studies comparing citrate with heparin anticoagulation for CRRT

		Circuit life (hours)^a		Bleeding		Transfusion (RBC/day^b)		Survival
Reference	Design	Citrate	Heparin	Citrate	Heparin	Citrate	Heparin	Citrate	Heparin
Monchi and colleagues [63]	RCOT, n = 20	70 (44 to 140), P < 0.001	40 (17 to 48)	n = 0	n = 1	0.2 (0 to 0.4), P < 0.001	1.0 (0 to 2.0)
Kutsogiannis and colleagues [64]	RCT, n = 30	125 (95 to 157), P < 0.001	38 (25 to 62)	RR 0.17 (0.03 to 1.04), P = 0.06		0.53 (0.24 to 1.20), P = 0.13
Betjes and colleagues [65]	RCT, n = 48			0%, P < 0.01	33%	0.43, P = 0.01	0.88
Oudemans-Van Straaten and colleagues [35]	RCT^c, n = 200	27 (13 to 47), NS	26 (15 to 43)	6%, P = 0.08	16%	0.27 (0 to 0.63), P = 0.31	0.36 (0 to 0.83)	52%^d, P = 0.03	37%^d
Hetzel and colleagues [66]	RCT, n = 170	37.5 ± 23, P < 0.001	26.1 ± 19.2	14.5%, P = 0.06	5.7%			± 30%^e, NS	± 43%^e

CRRT, continuous renal replacement therapy; RCOT, randomized cross-over trial; RCT, randomized controlled trial; NS, not significant; RR, relative risk. ^aMedian (interquartile range). ^bNumber of red cell units per day of continuous venovenous hemofiltration. ^cComparing citrate with the low molecular weight heparin nadroparin. ^dThree-month survival on an intention-to-treat analysis. ^eThirty-day mortality, estimated from the Kaplan-Meier curve.

ISSN: 1364-8535