The effects of heparin and citrate anticoagulation regimes on unmeasured anion acidosis during continuous renal replacement therapy in acute kidney injury


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Sarıkaya Z. T. , Doğan L., Güçyetmez B.

23. International Intensive Care E-Symposium, İstanbul, Turkey, 19 - 22 May 2021

  • Publication Type: Conference Paper / Summary Text
  • City: İstanbul
  • Country: Turkey

Abstract

The effects of heparin and citrate anticoagulation regimes on unmeasured anion acidosis during continuous renal replacement therapy in acute kidney injury


Z. Tuğçe SARIKAYA, Lerzan DOĞAN, Bülent GÜÇYETMEZ


Introduction/Purpose

The aim of the study was to investigate the effects of heparin anticoagulation (HA) and regional citrate anticoagulation (RCA) on unmeasured anion (UA) acidosis in patients with acute kidney injury (AKI) undergoing continuous renal replacement therapy (CRRT) (1,2).

Materials And Method

Twenty-seven patients who performed CRRT due to AKI were prospectively evaluated. Patients, whose anticoagulant regimes were determined by physicians, were divided into 2 groups in accordance with anticoagulant regimes as HA and RCA. At the 2nd hour of the CRRT, blood samples were taken from both lines of the dialysis catheter (the line from patient to the filter and line from the filter to the patient). Demographic data, blood gas parameters, magnesium, phosphorus and albumin, strong ion gap (SIG) and delta-SIG (post-filter SIG minus pre-filter SIG) values and outcomes were recorded. SPSS version 27 was used for statistical analysis. Chi-square, student-t and Mann-Whitney U tests were used for comparison between groups. 

Findings

HA was used in 9 (33.3%) patients whereas RCA was used in 18 (66.7%) patients. Demographic data, creatinine and urea levels before CRRT, prefilter blood gas parameters and outcomes were similar in two groups. In the RCA group, postfilter HCO3, SBE and Ca level were significantly lower whereas SIG was significantly higher than HA group (p<0.001 for all). Delta-SIG value in RCA group was significantly higher than HA group (p<0.001).

Discussion / Conclusion

The main purpose of CRRT in patients with AKI is to remove UAs from the blood. Apparently, UAs increase when administering RCA during CRRT. Therefore, it should be kept in mind that CRRT with HA can be primarily preferred in patients with AKI if there is no contraindication.

1. Khwaja A. Nephron. 2012:179–84. 

2. Stucker F et al. Crit Care. 2015;1:91.