PMID- 30983172
OWN - NLM
STAT- MEDLINE
DCOM- 20191206
LR  - 20191217
IS  - 1724-5990 (Electronic)
IS  - 0393-5590 (Linking)
VI  - 36
IP  - 2
DP  - 2019 Apr
TI  - [Choice and management of anticoagulation during CRRT].
LID - 2019-vol2 [pii]
AB  - Continuous renal replacement therapies (CRRT) are widely used in the treatment of 
      acute kidney injury. Several causes, related to the treatment itself or to the 
      patient's condition, determine the coagulation of the extracorporeal circuit. 
      These interruptions (or down-time) have a negative impact on the effectiveness of 
      the treatment in terms of solute clearance and fluid balance. Historically, the 
      choice of anticoagulant has fallen on unfractionated heparin because it is cheap 
      and easy to use. Today, the use of citrate is recommended in most instances 
      because of its high efficacy and safety. Several studies demonstrate the 
      superiority of citrate in terms of filter survival. The reduction of down-time 
      results in a reduction of the delta between the prescribed dialysis dose and the 
      dose that is actually administered (ml/Kg/hour of collected effluent). The 
      literature also agrees that there is a reduction in the incidence of major 
      bleeding events when citrate is used instead of heparin, although there is no 
      impact on mortality rates. Some technical and clinical complexities, secondary to 
      citrate action both as anticoagulant and buffer, still exist in the use of 
      regional citrate anticoagulation. However, complications due to citrate use, such 
      as acid-base balance disorders and hypocalcaemia, are rare and easily reversible. 
      There is not much data about the costs and benefits of using citrate instead of 
      heparin; according to the experience within our own Unit, we have observed a 
      reduction in costs when the data is normalized for 35 ml of effluent 
      administered. Appropriate protocols, accurate surveillance and the automated 
      management of regional citrate anticoagulation thanks to dedicated software make 
      this technique safe and effective.
CI  - Copyright by Societa Italiana di Nefrologia SIN, Rome, Italy.
FAU - Ricci, Davide
AU  - Ricci D
AD  - U.O. Nefrologia Dialisi e Ipertensione, Policlinico S.Orsola-Malpighi, Bologna, 
      Italia.
FAU - Panicali, Laura
AU  - Panicali L
AD  - U.O. Nefrologia Dialisi e Ipertensione, Policlinico S.Orsola-Malpighi, Bologna, 
      Italia.
FAU - Cavallari, Giuseppe
AU  - Cavallari G
AD  - U.O. Nefrologia Dialisi e Ipertensione, Policlinico S.Orsola-Malpighi, Bologna, 
      Italia.
FAU - Facchini, Maria Grazia
AU  - Facchini MG
AD  - U.O. Nefrologia Dialisi e Ipertensione, Policlinico S.Orsola-Malpighi, Bologna, 
      Italia.
FAU - Mancini, Elena
AU  - Mancini E
AD  - U.O. Nefrologia Dialisi e Ipertensione, Policlinico S.Orsola-Malpighi, Bologna, 
      Italia.
LA  - ita
PT  - Journal Article
PT  - Review
PL  - Italy
TA  - G Ital Nefrol
JT  - Giornale italiano di nefrologia : organo ufficiale della Societa italiana di 
      nefrologia
JID - 9426434
RN  - 0 (Anticoagulants)
RN  - 0 (Buffers)
RN  - 2968PHW8QP (Citric Acid)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Acute Kidney Injury/*therapy
MH  - Anticoagulants/*administration & dosage/adverse effects
MH  - *Blood Coagulation
MH  - Buffers
MH  - Citric Acid/*administration & dosage/adverse effects
MH  - Hemorrhage/chemically induced/prevention & control
MH  - Heparin/administration & dosage
MH  - Humans
MH  - *Renal Replacement Therapy/methods
MH  - Water-Electrolyte Balance
OTO - NOTNLM
OT  - CRRT
OT  - acute kidney injury
OT  - anticoagulation
OT  - citrate
EDAT- 2019/04/16 06:00
MHDA- 2019/12/18 06:00
CRDT- 2019/04/16 06:00
PHST- 2019/04/16 06:00 [entrez]
PHST- 2019/04/16 06:00 [pubmed]
PHST- 2019/12/18 06:00 [medline]
AID - 36-2-2019-5 [pii]
PST - ppublish
SO  - G Ital Nefrol. 2019 Apr;36(2):2019-vol2.