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Table 1 Comparison between three large randomized controlled trials comparing citrate to heparin anticoagulation for continuous venovenous hemofiltration

From: Citrate for continuous renal replacement therapy: safer, better and cheaper

  CASH trial 2014 [1] (multicenter) OLVG trial 2009 [2] (single center) Hetzel trial 2011 [3] (multicenter)
Excluded (percentage of patients needing CRRT) 1,297/2,300 (94%) 170/385 (44%) Not reported
Modality Predilution CVVH Postdilution CVVH Predilution CVVH
Groups Citrate Heparin P value Citrate LMWH P value Citrate Heparin P value
Number of included patients 66 73   97 103   87 83  
Patient characteristics          
Age 67 (36–87) 67 (23–85)   73 (64–79) 73 (67–79)   62 (SD 15) 65 (SD 12)  
APACHE II 23 (11–53) 25 (6–43)   28 (27–30) 28 (27–29)   22 (SD 5.1) 22 (SD 5.5)  
SOFA 10 (2–19) 11 (3–18)   11 (10–13) 11 (10–14)   10 (SD 3.0) 10 (SD 2.6)  
Cause of acute kidney injury a          
  Septic 41% 37%   43% 49%   77% 75%  
  Ischemic (cardiogenic + hypovolemic) 50% 51%   80% 61%   Not reported
Safety          
Adverse events needing discontinuation 5 (8%) 24 (33%) <0.001 2 (2%) 19 (19%) <0.001    
Bleeding percentage b 3 (5%) 10 (14%) 0.09 0 (0%) 16 (16%) <0.001 5 (5.7%) 12 (14.7%) 0.09
Citrate accumulation 4 (6%)    1 (1%)    1 (1%)   
Efficacy          
Circuit survival (hours) c 46 (2–138) 32 (1–72) 0.02 27 (13–47) 26 (15–43) 0.68 38 (SD 23) 26 (SD 19) <0.001
Mortality          
90-day 42% 42% 1.00 48% 63% 0.03    
28-day 33% 35% 1.00     47% 41%  
  1. Values are median (25th to 75th percentile), means (standard deviation (SD)), number (%). aMore causes possible. bCriteria for bleeding differed between studies. cCalculated for the first filter in the CASH trial, and for all filters in the other two. APACHE, Acute Physiology and Chronic Health Evaluation; CASH, Citrate Anticoagulation Versus Systemic Heparinization; CRRT, continuous renal replacement therapy; CVVH, continuous venovenous hemofiltration; LMWH, low molecular weight heparin; OVLG, Onze Lieve Vrouwe Gasthuis; SOFA, Sequential Organ Failure Assessment.