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Abstract: TH-PO044

Efficacy of Regional Citrate vs. Heparin Anticoagulation in Patients With AKI Requiring Continuous Renal Replacement Therapy: A Randomized Study

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical‚ Outcomes‚ and Trials


  • Bhalla, Anil, Sir Ganga Ram Hospital, New Delhi, Delhi, India
  • Bhandari, Gaurav Mahendra, Sir Ganga Ram Hospital, New Delhi, Delhi, India
  • Tiwari, Vaibhav, Sir Ganga Ram Hospital, New Delhi, Delhi, India
  • Bhargava, Vinant, Sir Ganga Ram Hospital, New Delhi, Delhi, India
  • Gupta, Anurag, Sir Ganga Ram Hospital, New Delhi, Delhi, India
  • Malik, Manish, Sir Ganga Ram Hospital, New Delhi, Delhi, India
  • Gupta, Ashwani, Sir Ganga Ram Hospital, New Delhi, Delhi, India
  • Rana, Devinder S., Sir Ganga Ram Hospital, New Delhi, Delhi, India

For the functioning of any Renal replacement treatment (RRT) and adequate hemoperfusion, it needs anticoagulation to prevent the extracorporeal circuit from clotting. Although heparin is cheap and easy monitoring can be done, bleeding risks are high. Regional citrate anticoagulation (RCA) acts only in the extracorporeal circuit and thus appears safe.


A RCT was conducted in the Intensive Care Unit of this hospital. AKI patients requiring CRRT were randomized into 2 groups based on anticoagulation used. Group 1 - RCA as anticoagulation while group 2 was the heparin group. A total of 52 patients were taken, equally divided into two groups. Efficacy and safety parameters were analyzed in both groups.

Outcome measures: Filter lifespan, effective delivered RRT dose, number of bleeding episodes, hypocalcemia, citrate toxicity (ratio of total calcium to ionized calcium), and metabolic complications.


Demographic data were comparable amongst both the groups. Sepsis was the most common cause of hospital admission in both groups (38.5% vs 50%). Oliguria was the most common indication for CRRT (53.8% in the RCA group and 61.5% in the heparin group). Mean filter lifespan in the RCA group was 45.11 hours while in the heparin group was 26.11 hours and it was clinically significant (P <0.001). The mean effective delivered RRT dose was higher in the RCA group (26 ml/kg/hour) compared to the heparin group (24.23 ml/kg/hour) and was clinically significant (P <0.001). Bleeding was higher in the heparin group than RCA group (42.3% vs 11.5%) and it was clinically significant (P = 0.027). 4 patients (15.4%) experienced hypocalcemia in the RCA group but were corrected with calcium and decreasing RCA dose. Zero cases of citrate toxicity were seen and only two patients (7.7%) were found to have metabolic alkalosis which was also corrected by reducing the RCA dose and stopping bicarbonate infusion if going on.


In critically ill patients with AKI on CRRT, regional citrate anticoagulation, when compared to systemic heparin, is safe and more effective than heparin. Heparin was associated with significant bleeding complications and increased heparin-induced thrombocytopenia episodes.