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Revista Iberoamericana de Educación e Investigación en Enfermería

Revista Iberoamericana de Educación e Investigación en Enfermería

ENERO 2021 N° 1 Volumen 11

Anticoagulation with 4% citrate and filter half-life in crrt in critical patients

Section: Reviews

How to quote

Pool-Cordero MB, Novelo-Góngora A, May-Uitz S. Anticoagulación con citrato al 4% y vida media del filtro en TRRC en pacientes críticos. Rev. iberoam. Educ. investi. Enferm. 2021; 11(1):27-37.

Authors

1 Marcela Beatriz Pool-Cordero, 2 Andony Novelo-Góngora, 3 Saúl May-Uitz

Position

1 Licenciado/a en Enfermería. Universidad Autónoma de Yucatán. Facultad de Enfermería. Unidad de Postgrado e Investigación. Especialización en Enfermería en Terapia Intensiva. México.2 Licenciado/a en Enfermería. Universidad Autónoma de Yucatán. Facultad de Enfermería. Unidad de Postgrado e Investigación. Especialización en Enfermería en Terapia Intensiva. México.3 Doctor en Ciencias de Enfermería. Docente de tiempo completo en Universidad Autónoma de Yucatán. Facultad de Enfermería. Unidad de Posgrado e Investigación. México.

Contact email: marce.pcordero@gmail.com

Abstract

Introduction: continuous renal replacement therapy (CRRT) is an alternative to replace kidney function in critical patients with acute kidney injury (AKI). The use of anticoagulation strategies to ensure increased filter survival is an important intervention in practice. A commonly used anticoagulant is unfractionated heparin, but other anticoagulants have also been shown to be effective.
Purpose: to assess whether regional anticoagulation with 4% citrate prolongs filter half-life compared to unfractionated heparin during CRRT in critically ill adult patients, by means of a literature review.
Methods: a literature review using the evidence-based nursing (EBN) method. The literature search was made in the databases PubMed, SpringerLink, Wiley Online Library, LILACS, and ScienceDirect. Papers published in the last five years in English or Spanish were included. Boolean operators AND/NOT were used as a search strategy. Previously established eligibility and exclusion criteria were applied. The quality of evidence was evaluated through CASPe program tools. SING and Sackett scales were used for interpretation to assign levels of evidence and strengths of recommendation.
Results: 42 articles were selected that met the eligibility criteria, based on critical reading and grading of the level of evidence; of them, 10 were selected.
Conclusion: regional anticoagulation with citrate is an effective strategy to extend the half-life of the extracorporeal filter in CRRT. Moreover, it decreases complications associated with anticoagulation and the risk of obstruction.

Keywords:

sodium citrate; heparin; anticoagulants; adults; intensive care unitcontinuous renal replacement therapy

Versión en Español

Título:

ANTICOAGULACIÓN CON CITRATO AL 4% Y VIDA MEDIA DEL FILTRO EN TRRC EN PACIENTES CRÍTICOS

Artículo completo no disponible en este idioma / Full article is not available in this language

Bibliography

  1. Libório AB, Leite TT, De Oliveira Neves FM, Teles F, De Melo Bezerra CT. AKI complications in critically ill patients: Association with mortality rates and RRT. Clin J Am Soc Nephrol. 2015; 10(1):21-8.
  2. Samuel Chávez-Iñiguez J, García-García G, Lombardi R. Epidemiología y desenlaces de la lesión renal aguda en Latinoamérica Correspondencia. Gac Med Mex. 2018; 1:6-14.
  3. Torres-Toledano M, Granados-García V, López-Ocaña RL, Torres Toledano M. Carga de la enfermedad renal crónica en México. Rev Med Inst Mex Seguro Soc. 2017; 55(Supl 2):S118-23.
  4. Cortés-Sanabria L, Álvarez-Santana G, Orozco-González CN, Soto-Molina H, Martínez-Ramírez RH, Martín Cueto-Manzano A. Aportaciones originales Impacto económico de la enfermedad renal crónica: Perspectiva del Instituto Mexicano del Seguro Social. Rev Med Inst Mex Seguro Soc. 2017; 55(2):S124-32.
  5. Kindgen-Milles D, Brandenburger T, Dimski T. Regional citrate anticoagulation for continuous renal replacement therapy. Curr Opin Crit Care. 2018; 24(6):450-4.
  6. Rizo-Topete L, Juncos L. Anticoagulación en terapia de reemplazo renal continua. Gac Med Mex. 2018; 154(1):61-71.
  7. Sosa-Medellin MA, Luviano-Garcia JA. Terapia de reemplazo renal continua. Conceptos, indicaciones y aspectos básicos de su programación. Med Int Mex. 2018; 34(2):288-98.
  8. Sorrosal SA, Marín LMR, Torres F, Jiménez VV, de Briñas EPL. Two anticoagulation methods in continuous extra-renal depuration techniques. Enferm Nefrol. 2018; 21(1):9-17.
  9. Al-Ali F, Hamdy AF, Hamad A, Elsayed M, Zafar Iqbal Z, Elsayed A, et al. Safety and efficacy of taurolidine/urokinase versus taurolidine/heparin as a tunneled catheter lock solution in hemodialysis patients: a prospective, randomized, controlled study. Nephrol Dial Transplant. 2018; 33(4):619-26.
  10. Fiaccadori E, Pistolesi V, Mariano F, Mancini E, Canepari G, Inguaggiato P, et al. Regional citrate anticoagulation for renal replacement therapies in patients with acute kidney injury: a position statement of the Work Group “Renal Replacement Therapies in Critically Ill Patients” of the Italian Society of Nephrology. Journal of Nephrology. Springer New York LLC; 2015. Vol. 28. p. 151-64.
  11.  Descriptores de Ciencias de la Salud (DeCS) [internet]. BIREME/OMS/OPS. Sao Paulo; 2020 [citado 16 dic 2020]. Disponible en: https://decs.bvsalud.org/
  12. Medical Subject Headings (MeSH) [internet]. PubMed Search Strategies. Nacional Library of Medicine, NLM; 2020 [citado 16 dic 2020]. Disponible en: https://www.ncbi.nlm.nih.gov/mesh
  13. Caballero JB. por CASPe. Plantilla para ayudarte a entender un Estudio de Casos y Controles. Alicante: En: CASPe. Guías CASPe de Lectura Crítica de la Literatura Médica; 2005. p. 13-9.
  14. Caballero JB. por CASPe. Plantilla para ayudarte a entender un Revisión Sistemática. CASPe. Guías CASPe de Lectura Crítica de la Literatura Médica. Alicante: En: CASPe; 2005. p. 13-7.
  15. Caballero J. por CASPe. Plantilla para ayudarte a entender un Ensayo Clínico. CASPe. Guías CASPe de Lectura Crítica de la Literatura Médica. Alicante: Cuaderno I; 2005. p. 5-8.
  16. Wu B, Zhang K, Xu B, Ji D, Liu Z, Gong D. Randomized Controlled Trial to Evaluate Regional Citrate Anticoagulation Plus Low-Dose of Dalteparin in Continuous Veno-Venous Hemofiltration. Blood Purif. 22 de julio de 2015; 39(4):306-12.
  17. Schilder L, Nurmohamed SA, Ter Wee PM, Paauw NJ, Girbes ARJ, Beishuizen A, et al. Coagulation, Fibrinolysis and Inhibitors in Failing Filters during Continuous Venovenous Hemofiltration in Critically Ill Patients with Acute Kidney Injury: Effect of Anticoagulation Modalities. Blood Purif. 2015; 39(4):297-305.
  18. Gattas DJ, Rajbhandari D, Bradford C, Buhr H, Lo S, Bellomo R. A randomized controlled trial of regional citrate versus regional heparin anticoagulation for continuous renal replacement therapy in critically ill adults. Crit Care Med. 2015; 43(8):1622-9.
  19. Bai M, Zhou M, He L, Ma F, Li Y, Yu Y, et al. Citrate versus heparin anticoagulation for continuous renal replacement therapy: an updated meta-analysis of RCTs. Intensive Care Medicine. Springer Verlag; 2015. Vol. 41. p. 2098-110.
  20. Stucker F, Ponte B, Tataw J, Martin PY, Wozniak H, Pugin J, et al. Efficacy and safety of citrate-based anticoagulation compared to heparin in patients with acute kidney injury requiring continuous renal replacement therapy: A randomized controlled trial. Crit Care. 2015; 19(1).
  21. Liu C, Mao Z, Kang H, Hu J, Zhou F. Regional citrate versus heparin anticoagulation for continuous renal replacement therapy in critically ill patients: A meta-analysis with trial sequential analysis of randomized controlled trials. Crit Care. 2016; 20(1).
  22. Zhang C, Lin T, Zhang J, Liang H, Di Y, Li N, et al. Safety and efficacy of regional citrate anticoagulation in continuous renal replacement therapy in the presence of acute kidney injury after hepatectomy. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2018; 30(8):777-82.
  23. Tuerdi B, Zuo L, Sun H, Wang K, Wang Z, Li G. Safety and efficacy of regional citrate anticoagulation in continuous blood purification treatment of patients with multiple organ dysfunction syndrome. Brazilian J Med Biol Res. 2018; 51(1):1-8.
  24. Zhang W, Bai M, Yu Y, Li L, Zhao L, Sun S, et al. Safety and efficacy of regional citrate anticoagulation for continuous renal replacement therapy in liver failure patients: A systematic review and meta-analysis. Crit Care. 2019; 23(1):22.
  25. Lin T, Song L, Huang R, Huang Y, Tang S, Lin Q, et al. Modified regional citrate anticoagulation is optimal for hemodialysis in patients at high risk of bleeding: A prospective randomized study of three anticoagulation strategies. BMC Nephrol. 2019; 20(1):472-86.
  26. Wu B, Zhang K, Xu B, Ji D, Liu Z, Gong D. Randomized Controlled Trial to Evaluate Regional Citrate Anticoagulation Plus Low-Dose of Dalteparin in Continuous Veno-Venous Hemofiltration. Blood Purif. 2015; 39(4):306-12.