Circuit Lifetime With Citrate Versus Heparin in Pediatric Continuous Venovenous Hemodialysis. (Duke)

Zaoral T, et al. Circuit Lifetime With Citrate Versus Heparin in Pediatric Continuous Venovenous Hemodialysis. Pediatr Crit Care Med. 2016 Sep;17(9):e399-405.

OBJECTIVES: To determine if there is a difference between regional citrate and global heparinized anticoagulation on circuit lifetimes during continuous venovenous hemodialysis in children.

DESIGN: Prospective “cross-over” trial.

SETTING: PICU, Department of Pediatrics, University Hospital Ostrava.

PATIENTS: Children 0-18 years old.

INTERVENTIONS: From 2009 to 2014, 63 eligible children (age, 89.24 ± 62.9 mo; weight, 30.37 ± 20.62 kg) received at least 24 hours of continuous venovenous hemodialysis. Each child received four continuous venovenous hemodialysis circuits with anticoagulants in the following order: heparin, citrate, heparin, citrate. Circuit life ended when transmembrane pressure was greater than or equal to 250 mm Hg for more than 60 minutes.

MEASUREMENTS AND MAIN RESULTS: The total mean circuit lifetime was 39.75 ± 10.73 hours. Citrate had a significantly longer median circuit lifetime (41.0 hr; CI, 37.6-44.4) than heparin (36.0 hr; CI, 35.4-36.6; p = 0.0001). Mortality was 33.33%. Circuit lifetime was significantly correlated to patient age (r = 0.606), weight (r = 0.763), and blood flow rate (r = 0.697). Transfusion rates (units of red cells per circuit of continuous venovenous hemodialysis) were 0.17 (0.0-1.0) with citrate and 0.36 (0.0-2.0) with heparin (p = 0.002).

CONCLUSIONS: We showed in our study that citrate provided significantly longer circuit lifetimes than heparin for continuous venovenous hemodialysis in children. Citrate was superior to heparin for the transfusion requirements. Citrate was feasible and safe in children and infants.