Regional citrate anticoagulation in renal replacement therapy in the intensive care station : Recommendations from the renal section of the DGIIN, ÖGIAIN and DIVI

• Published in: Medizinische Klinik, Intensivmedizin und Notfallmedizin Vol. 113; no. 5; pp. 377 - 383
• Main Authors: Schmitz, M, Joannidis, M, Czock, D, John, S, Jörres, A, Klein, S J, Oppert, M, Schwenger, V, Kielstein, J, Zarbock, A, Kindgen-Milles, D, Willam, C
• Format: Journal Article
• Language: German
• Published: Germany 01.06.2018
• Subjects: Acute Kidney Injury - therapy; Anticoagulants - therapeutic use; Citrates; Citric Acid - therapeutic use; Critical Care; Humans; Renal Replacement Therapy; Heparin; Calcium; Acidosis; Hemodialysis; Hemofiltration
• ISSN: 2193-6226
• DOI: 10.1007/s00063-018-0445-7

Regional citrate anticoagulation (RCA) in continuous renal replacement therapy can effectively anticoagulate dialysis circuits without having adverse effects on systemic heparin application. In particular, in continuous renal replacement therapy RCA is well established and represents a safe procedure with longer filter lifetimes and fewer bleeding complications. To provide guidance on the indications, advantages and disadvantages, and use of RCA, current recommendations from the renal section of the DGIIN (Deutschen Gesellschaft für Internistische Intensivmedizin und Notfallmedizin), ÖGIAIN (Österreichischen Gesellschaft für Internistische und Allgemeine Intensivmedizin und Notfallmedizin) and DIVI (Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin) are stated. The recommendations in this paper are based on the current KDIGO (Kidney Disease: Improving Global Outcomes) guidelines, other published guidelines and protocols as well as the expert knowledge and clinical experience of the authors. The use of commercially available machines with coupled pumps and integrated safety features, effective personal training and standardized protocols for clinical usage (SOP) is particularly important for the safe clinical use of RCA in renal replacement therapy. Contrary to previous recommendations, even liver failure or shock with lactic acidosis may no longer be an absolute contra-indication for RCA. However, these particular patients have to be carefully monitored for signs of citrate accumulation.