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Research progress in the citrate-based replacement fluids for continuous renal replacement therapy

  • TONG Shuang ,
  • LIN Qiao-Xuan ,
  • WANG Min-Min ,
  • WANG Lei
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  • Department of Medical Affairs and Clinical Development, Baxter China Ltd, Shanghai 200031, China; 2Department of Nephrology, Peking University People's Hospital, Beijing 100044, China

Received date: 2024-05-23

  Revised date: 2024-07-19

  Online published: 2025-01-12

Abstract

Anticoagulation strategy ensures filter patency and delivery of an adequate continuous renal replacement therapy (CRRT) dose. Most guidelines recommend the regional citrate anticoagulation (RCA) as the first-line method for patients requiring CRRT. Previous use of the traditional regional citrate anticoagulation had several drawbacks such as complex operation, risks of acid-base imbalance and metabolic disorders, leading to the restriction of its clinical applications. By contrast, citrate-based replacement fluids solve these deficiencies. This article reviews the research progress in citrate-based replacement fluids from point of view of  anticoagulation effectiveness, treatment efficiency and security.

Cite this article

TONG Shuang , LIN Qiao-Xuan , WANG Min-Min , WANG Lei . Research progress in the citrate-based replacement fluids for continuous renal replacement therapy[J]. Chinese Journal of Blood Purification, 2025 , 24(01) : 49 -53 . DOI: 10.3969/j.issn.1671-4091.2025.01.010

References

[1]Chinese Society of Nephrology.Guidelines for the anticoagulant management of continuous renal replacement therapy[J].Chinese Journal of Nephrology, 2022, 38(11):1016-1024 [2] Zhou, Y, Zhou, F., Wang, X., et al..Practice of Extracorporeal Therapies for Septic Acute Kidney Injury Patients in Intensive Care Units in Mainland China.[J].Blood purification, 2019, 47(Suppl 3):1-6 [3]Arif Khwaja.KDIGO clinical practice guidelines for acute kidney injury[J].Nephron Clin Pract., 2012, 120((4)):c179-c184 [4]共识专家组.抗凝技术在危重症肾脏替代治疗应用的中国专家共识年版[J].中华肾脏病杂志, 2023, 39(2):155-164 [5]陈香美等.血液净化标准操作规程. 人民卫生出版社. 2021. [6]许元文, 黄娜娅, 李水, 等.应重视枸橼酸抗凝在血液净化中的应用[J].中华医学杂志, 2023, 103(8):541-544 [7] Legrand M, Tolwani A.Anticoagulation strategies in continuous renal replacement therapy.[J].Semin Dial., 2021, 34((6)):416-422 [8] Zarbock, A, Küllmar, M., Kindgen-Milles, D., et al..Effect of Regional Citrate Anticoagulation vs Systemic Heparin Anticoagulation During Continuous Kidney Replacement Therapy on Dialysis Filter Life Span and Mortality Among Critically Ill Patients With Acute Kidney Injury: A Randomized Clinical Trial. [J].JAMA, 2020, 324(16):1629-1639 [9]王敏敏, , 俞雯艳, 姚强.连续性肾脏替代治疗局部枸橼酸抗凝与肝素抗凝不良事件的系统性评价及试验序贯分析[J].临床肾脏病杂志, 2023, 23(10):825-834 [10] Liu SY, Xu SY, Yin L, et al.Emergency Medical Doctor Branch of the Chinese Medical Doctor Association. Management of regional citrate anticoagulation for continuous renal replacement therapy: guideline recommendations from Chinese emergency medical doctor consensus.[J].Mil Med Res., 2023, 10(23): - [11]Cui Q, Sun F, Liu S, et al.A survey of regional citrate anticoagulation for emergency continuous renal replacement therapy]. [J].Zhonghua Wei Zhong Bing Ji Jiu Yi Xue., 2020, 32:595-600 [12]胡新, 毛智, 李青霖, 等.新型含枸橼酸无钙置换液在重症患者血液净化治疗中的抗凝效果[J].解放军医学杂志, 2020, 45(12):1259-1264 [13]Bianchi, NA., Altarelli, M., Eckert, P., & Schneider, A. G..Complications of Regional Citrate Anticoagulation for Continuous Renal Replacement Therapy: An Observational Study.[J].Blood purification, 2020, 49(5):567-55 [14]Pistolesi V, Morabito S, Pota V, et al.Regional citrate anticoagulation (RCA) in critically ill patients undergoing renal replacement therapy (RRT): expert opinion from the SIAARTI-SIN joint commission.[J].J Anesth Analg Crit Care., 2023, 3(1):7- [15] Ichai, C, Quintard, H., Velly, L. .Acid-Base Disorders and Regional Citrate Anticoagulation with Continuous Renal Replacement Therapy. In: Vincent, JL. [J].Annual Update in Intensive Care and Emergency Medicine, 2019, :383-396 [16]Zhang W, Bai M, Yu Y, et al.Safety and efficacy of regional citrate anticoagulation for continuous renal replacement therapy in liver failure patients: a systematic review and meta-analysis.[J].Crit Care., 2019, 23(1):22- [17]Jacobs R, Verbrugghe W, Dams K, et al..Regional Citrate Anticoagulation in Continuous Renal Replacement Therapy: Is Metabolic Fear the Enemy of Logic? A Systematic Review and Meta-Analysis of Randomised Controlled Trials.[J].Life, 2023, 13(5):1198- [18]Lenga I, Hopman WM, O' Connell AJ, Hume F, Wei CCY. 2019; 20(1):452.[J].BMC Nephrol., 2019, 20(1):452- [19]Stucker F, Ponte B, Tataw 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.[J].Crit Care., 2015, 19(1):91- [20]Egi M, Naka T, Bellomo R, et al.A comparison of two citrate anticoagulation regimens for continuous veno-venous hemofiltration.[J].Int J Artif Organs., 2005, 28(12):1211-1218 [21]Naka T, Egi M, Bellomo R, et al.Commercial low-citrate anticoagulation haemofiltration in high risk patients with frequent filter clotting.[J].Anaesth Intensive Care., 2005, 33(5):601-608 [22]Ratanarat R, Phairatwet P, Khansompop S, et al.Customized Citrate Anticoagulation versus No Anticoagulant in Continuous Venovenous Hemofiltration in Critically Ill Patients with Acute Kidney Injury: A Prospective Randomized Controlled Trial.[J].Blood Purif., 2023, 52(5):455-463 [23]Tolwani AJ, Prendergast MB, Speer RR, et al.A practical citrate anticoagulation continuous venovenous hemodiafiltration protocol for metabolic control and high solute clearance.[J].Clin J Am Soc Nephrol., 2006, 1(1):79-87 [24]Domingo, D, Jonathan, P., Fernando, S., et al..Regional Citrate Anticoagulation in Continuous Renal Replacement Therapies. International Journal of Critical Care and Emergency Medicine. [25]Morabito S, Pistolesi V, Tritapepe L, et al.Regional citrate anticoagulation in cardiac surgery patients at high risk of bleeding: a continuous veno-venous hemofiltration protocol with a low concentration citrate solution.[J].Regional citrate anticoagulation in cardiac surgery patients at high risk of bleeding: a continuous veno-venous hemofiltration protocol with a low concentration citrate solution., 2012, 16(3):- [26]Schmitz M, Taskaya G, Plum J, et al.Continuous venovenous haemofiltration using a citrate buffered substitution fluid.[J].Anaesth Intensive Care., 2007, 35(4):529-535 [27] Schilder L, Nurmohamed SA, Bosch FH, et al.Citrate anticoagulation versus systemic heparinisation in continuous venovenous hemofiltration in critically ill patients with acute kidney injury: a multi-center randomized clinical trial.[J].Crit Care., 2014, 18(4):472- [28] Leung AK, Shum HP, Chan KC, Chan SC, et al.A retrospective review of the use of regional citrate anticoagulation in continuous venovenous hemofiltration for critically ill patients.[J].Crit Care Res Pract., 2013, :349-512 [29] Hetzel GR, Schmitz M, Wissing H, et al.Regional citrate versus systemic heparin for anticoagulation in critically ill patients on continuous venovenous haemofiltration: a prospective randomized multicenter trial.[J]. Nephrol Dial Transplant., 2011, 26(1):232-239 [30]Jeffrey YH, Hoi-Ping S, Kit Hung AL, et al. 2017 Jan; 21(1):11-16.[J].Indian J Crit Care Med., 2017, 21(11):16- [31]Di Mario F, Sabatino A, Regolisti G, et al.Simplified regional citrate anticoagulation protocol for CVVH, CVVHDF and SLED focused on the prevention of KRT-related hypophosphatemia while optimizing acid-base balance. [J].Nephrol Dial Transplant., 2023, 38(10):2298-2309 [32]Morabito S, Pistolesi V, Tritapepe L, et al.Continuous veno-venous hemodiafiltration with a low citrate dose regional anticoagulation protocol and a phosphate-containing solution: effects on acid-base status and phosphate supplementation needs.[J].BMC Nephrol., 2013, 14:232- [33]Soltysiak J, Warzywoda A, Kociński B, et al.Citrate anticoagulation for continuous renal replacement therapy in small children. [J].Pediatr Nephrol. , 2014, 29(3):469-475 [34]Cappoli A, Labbadia R, Antonucci L, et al.A simplified protocol of regional citrate anticoagulation with phosphate-containing solutions in infants and children treated with continuous kidney replacement therapy.[J]. Pediatr Nephrol. , 2023, 38(11):3835-3844 [35]中关村肾病血液净化创新联盟专家组, 左力.连续性肾脏替代治疗置换液临床应用分类专家共识[J].中国血液净化, 2023, 22(10):721-725
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