Regional citrate anticoagulation (RCA) in critically ill patients undergoing renal replacement therapy (RRT): expert opinion from the SIAARTI-SIN joint commission

Valentina Pistolesi, Santo Morabito, Vincenzo Pota, Fabrizio Valente, Francesca Di Mario, Enrico Fiaccadori, Giacomo Grasselli, Nicola Brienza, Vincenzo Cantaluppi, Silvia De Rosa, Vito Fanelli, Marco Fiorentino, Marita Marengo, Stefano Romagnoli

Research output: Contribution to journalReview articlepeer-review

Abstract

Renal replacement therapies (RRT) are essential to support critically ill patients with severe acute kidney injury (AKI), providing control of solutes, fluid balance and acid–base status. To maintain the patency of the extracorporeal circuit, minimizing downtime periods and blood losses due to filter clotting, an effective anticoagulation strategy is required. Regional citrate anticoagulation (RCA) has been introduced in clinical practice for continuous RRT (CRRT) in the early 1990s and has had a progressively wider acceptance in parallel to the development of simplified systems and safe protocols. Main guidelines on AKI support the use of RCA as the first line anticoagulation strategy during CRRT in patients without contraindications to citrate and regardless of the patient’s bleeding risk. Experts from the SIAARTI-SIN joint commission have prepared this position statement which discusses the use of RCA in different RRT modalities also in combination with other extracorporeal organ support systems. Furthermore, advise is provided on potential limitations to the use of RCA in high-risk patients with particular attention to the need for a rigorous monitoring in complex clinical settings. Finally, the main findings about the prospective of optimization of RRT solutions aimed at preventing electrolyte derangements during RCA are discussed in detail.

Original languageEnglish
Article number7
JournalJournal of Anesthesia, Analgesia and Critical Care
Volume3
Issue number1
DOIs
Publication statusPublished - Dec 2023

Keywords

  • AKI
  • CRRT
  • Citrate
  • PIRRT
  • Regional citrate anticoagulation

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