Comparison of Regional Citrate Anticoagulation (RCA) with Heparin (HA) or No (NA) anticoagulation strategy in paediatric intensive care patients receiving continuous renal replacement therapy: A 9-year single centre tertiary cohort study

Background & Objective: This is a single centre retrospective cohort study over period of 9 years of comparing regional citrate anticoagulation (RCA) vs heparin (HA) or no anticoagulation (NA) strategy in a paediatric intensive care patients using continuous renal replacement therapy. Results: A total of 107 CRRT circuits were used to deliver continuous renal replacement therapy to 42 children weighing at least 8 kg. Overall mortality was 14 out of 42 (33.3%); similar between the RCA (22.2%, 4/18) and HA (25%, 4/16) group. Sepsis or shock was the most common indication for CRRT followed by acute kidney injury in both the groups. A single circuit was sufficient to complete the required CRRT therapy with RCA in 8 out of 14 children (57.1%), compared to only 3 out of 12 children (25%) with HA. The median number of circuits required per patient was 2 in the RCA group and 3.3 in the HA group. The median circuit lifespan was highest in RCA circuits, 27 hours (SD ± 3 hours), followed by HA circuits at 20 hours (SD ± 3.2 hours) and shortest in NA circuits, 8.2 hours (SD ± 4.2 hours). Clots was commonest reason leading to circuit changes and occurred in 8 out of 36 (22.2%) RCA circuits, 14 out of 52 (26.9%) HA circuits, and 8 out of 18 (44.4%) NA circuits. Conclusions: In our study, RCA circuits had longer median lifespans, required fewer changes, and had lower rates of clotting and bleeding complications. However, due to small sample size results were not statistically significant.