Abstract: SA-PO1093
Regional Citrate Anticoagulation During Extracorporeal Membrane Oxygenation-CRRT: A Systematic Review and Meta-Analysis with Reconstructed Time-to-Event Data
Session Information
- Kidney Replacement Therapy and Care Delivery Innovations
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Lins, Paulo Ricardo Gessolo, Universidade Federal de Sao Paulo, São Paulo, SP, Brazil
- Santos, Yuri Albuquerque Pessoa dos, Hospital Sirio-Libanes, São Paulo, SP, Brazil
- Besen, Bruno A M P, Universidade Federal de Sao Paulo, São Paulo, SP, Brazil
Background
Systemic unfractionated heparin (UFH) is the standard anticoagulation strategy during extracorporeal membrane oxygenation (ECMO). However, when continuous renal replacement therapy (CRRT) is performed during ECMO, premature filter/circuit clotting remains frequent. Recent data suggest that adding regional citrate anticoagulation (RCA) to systemic UFH may improve circuit patency.
Methods
We performed a systematic review and meta-analysis of studies comparing UFH plus RCA versus UFH alone in patients receiving ECMO-CRRT (PubMed, Embase, Cochrane). The primary outcome was CRRT filter clotting. Secondary outcomes included CRRT filter lifespan and reconstructed time to clotting. Random-effects models were used for pooled estimates, and pseudo-individual patient data were reconstructed for time-to-event analysis.
Results
Five studies including 446 patients (1,011 filters) were included. UFH plus RCA was associated with lower filter/circuit clotting compared with UFH alone (OR 0.34; 95% CI 0.19-0.61). In studies reporting circuit duration, UFH plus RCA increased filter lifespan (MD +17.8 hours; 95% CI 16.7-18.9). Reconstructed 72-hour time-to-event analysis showed lower cumulative clotting with UFH plus RCA (HR 0.51; 95% CI 0.36-0.74; P<0.001). Citrate accumulation/overload was uncommon, occurring in 2 of 93 RCA-treated patients with extractable event counts (2.2%) without CRRT interruption due to citrate-related complications.
Conclusion
In ECMO-CRRT, adding RCA to systemic UFH was associated with less CRRT filter/circuit clotting, longer circuit lifespan, and improved 72-hour circuit survival. These findings support RCA as a circuit-preservation strategy in this setting.
Acknowledgment
Prospero: CRD420261388709
Figure 1: Reconstructed 72-hour cumulative incidence of CRRT circuit clotting according to anticoagulation strategy.