PMID- 33688766
OWN - NLM
STAT- MEDLINE
DCOM- 20220408
LR  - 20220421
IS  - 1525-1489 (Electronic)
IS  - 0885-0666 (Linking)
VI  - 37
IP  - 5
DP  - 2022 May
TI  - A Meta-Analysis of Extracorporeal Anticoagulants in Pediatric Continuous Kidney 
      Replacement Therapy.
PG  - 577-594
LID - 10.1177/0885066621992751 [doi]
AB  - OBJECTIVE: Continuous kidney replacement therapy (CKRT) is the primary 
      therapeutic modality utilized in hemodynamically unstable patients with severe 
      acute kidney injury. As the circuit is extracorporeal, it poses an increased risk 
      of blood clotting and circuit loss; frequent circuit losses affect the provider's 
      ability to provide optimal treatment. The objective of this meta-analysis is to 
      evaluate the safety and efficacy of the extracorporeal anticoagulants in the 
      pediatric CKRT population. DATA SOURCES: We conducted a literature search on 
      PubMed/Medline and Embase for relevant citations. STUDY SELECTION: Studies were 
      included if they involved patients under the age of 18 years undergoing CKRT, 
      with the use of anticoagulation (heparin, citrate, or prostacyclin) as a part of 
      therapy. Only English articles were included in the study. DATA EXTRACTION: 
      Initial search yielded 58 articles and a total of 24 articles were included and 
      reviewed. A meta-analysis was performed focusing on the safety and effectiveness 
      of regional citrate anticoagulation (RCA) vs unfractionated heparin (UFH) 
      anticoagulants in children. DATA SYNTHESIS: RCA had statistically significantly 
      longer circuit life of 50.65 hours vs. UFH of 42.10 hours. Two major adverse 
      effects metabolic alkalosis and electrolyte imbalance seen more commonly in RCA 
      compared to UFH. There was not a significant difference in the risk of systemic 
      bleeding when comparing RCA vs. UFH. CONCLUSION: RCA is the preferred 
      anticoagulant over UFH due to its significantly longer circuit life, although 
      vigilant circuit monitoring is required due to the increased risk of electrolyte 
      disturbances. Prostacyclin was not included in the meta-analysis due to the lack 
      of data in pediatric patients. Additional studies are needed to strengthen the 
      study results further.
FAU - Raina, Rupesh
AU  - Raina R
AD  - Akron Nephrology Associates/Cleveland Clinic Akron General Medical Center, Akron, 
      OH, USA.
AD  - Department of Nephrology, Akron Children's Hospital, Akron, OH, USA.
FAU - Agrawal, Nirav
AU  - Agrawal N
AUID- ORCID: 0000-0002-3102-7228
AD  - Akron Nephrology Associates/Cleveland Clinic Akron General Medical Center, Akron, 
      OH, USA.
AD  - Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, USA.
FAU - Kusumi, Kirsten
AU  - Kusumi K
AD  - Department of Nephrology, Akron Children's Hospital, Akron, OH, USA.
FAU - Pandey, Avisha
AU  - Pandey A
AD  - Akron Nephrology Associates/Cleveland Clinic Akron General Medical Center, Akron, 
      OH, USA.
FAU - Tibrewal, Abhishek
AU  - Tibrewal A
AD  - Akron Nephrology Associates/Cleveland Clinic Akron General Medical Center, Akron, 
      OH, USA.
FAU - Botsch, Alexander
AU  - Botsch A
AD  - Division of Critical Care Medicine, Summa Health, Akron, OH, USA.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
DEP - 20210310
PL  - United States
TA  - J Intensive Care Med
JT  - Journal of intensive care medicine
JID - 8610344
RN  - 0 (Anticoagulants)
RN  - 0 (Electrolytes)
RN  - 2968PHW8QP (Citric Acid)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Adolescent
MH  - *Anticoagulants
MH  - Child
MH  - Citric Acid
MH  - *Continuous Renal Replacement Therapy
MH  - Electrolytes
MH  - Heparin
MH  - Humans
MH  - Renal Replacement Therapy
OTO - NOTNLM
OT  - CKRT
OT  - anticoagulants
OT  - citrate
OT  - heparin
OT  - pediatrics
OT  - prostacyclin
EDAT- 2021/03/11 06:00
MHDA- 2022/04/09 06:00
CRDT- 2021/03/10 12:13
PHST- 2021/03/11 06:00 [pubmed]
PHST- 2022/04/09 06:00 [medline]
PHST- 2021/03/10 12:13 [entrez]
AID - 10.1177/0885066621992751 [doi]
PST - ppublish
SO  - J Intensive Care Med. 2022 May;37(5):577-594. doi: 10.1177/0885066621992751. Epub 
      2021 Mar 10.