ESPN 53rd Annual Meeting

ESPN 2021


 
Regional citrate anticoagulation in pediatric CRRT
ANDREA CAPPOLI 1 RAFFAELLA LABBADIA 1 EMANUELE ROSSETTI 2 GABRIELLA BOTTARI 2 ISABELLA GUZZO 1

1- DIVISION OF NEPHROLOGY AND DIALYSIS, DEPARTMENT OF PEDIATRIC SUBSPECIALTIES, IRCCS BAMBINO GESù PEDIATRIC HOSPITAL, ROME ITALY
2- DEPARTMENT OF PEDIATRIC INTENSIVE CARE, OSPEDALE PEDIATRICO BAMBINO GESù-IRCC, ROME, ITALY
 
Introduction:

Acute kidney injury (AKI) is highly prevalent in hospitalized children, especially those in pediatric intensive care unit (PICU). Continuous renal replacement therapy (CRRT) is the treatment of choice in critically ill children with AKI but needs an anticoagulation of the extracorporeal circuit to prevent filter clotting. Regional citrate anticoagulation (RCA) is widely reported in adults, but pediatric data are still incomplete.

Material and methods:

We have treated twenty-one critically ill children admitted in pediatric intensive care units with CRRT using RCA. Mean age was 56,6 ± 71,1 months with mean body weight of 18,42 ± 21,6 kg. Severe AKI, intended as stage 3 KDIGO, was present in most of the patients (52.3%). Citrate dose adjustments were made by controlling the calcium in the circuit with a desired target, while calcium infusion was based on the ionized calcium of the patients. Filter life was recorded.

Results:

Mean filter lifetime was 51.9 ± 19.4 hours with 62.9% of circuits lasting more than 48 hours and 38.2% of circuits lasting more than 70 hours. In our experience, metabolic acidosis was more common than metabolic alkalosis, The most common metabolic complication was hyponatremia (defined as Na < 135 mmol/L), reflecting more the clinical conditions of these patients rather than complications of RCA. We found only a few episodes of hypocalcaemia, never clinically relevant, and treated with changes in calcium compensation. Only two patients presented citrate accumulation (CA), defined as a calcium ratio > 2.5, but neither of them presented clinical signs of CA with serum bicarbonate and lactate in order. Survival rate of our patients was 62 %. No patient developed treatment-related bleeding complications.

Conclusions:

In our experience regional citrate anticoagulation was safe and effective in preventing circuit clotting. RCA can be used for CRRT in children, even in the ones with very low body weight.