ESPN 54th Annual Meeting

ESPN 2022


 
Efficacy and safety of regional citrate anticoagulation in pCKRT
ANDREA CAPPOLI 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 kidney replacement therapy (CKRT) is the treatment of choice in critically ill children with AKI. One of the great challenges with CKRT is early coagulation of the circuit.

Material and methods:

Since December 2018, we have treated fifty critically ill children admitted in pediatric intensive care units with CKRT using regional citrate anticoagulation. Diagnosis for these patients were several, including septic shock, acute kidney injury, liver failure and hematological disorders. Patients were mainly male, mean age was 75.4 ± 77.5 months with mean body weight of 22.7 ± 22.8 kg. Twenty-seven patients were below 15 kg and fourteen patients were below 10 kg. Eleven patients had severe hepatic impairment and received a reduced dose of citrate.

Results:

The mean filter lifetime was 54.5 ± 18.2 hours with 70.6% of circuits lasting more than 48 hours and 45.2% of circuits lasting more than 70 hours. The most frequent cause of CKRT interruption was scheduled changes. Interestingly, similar circuit lifetime was also confirmed in the low weight sub-population ( 10 kg), 54.3 ± 19.2 hours. In our experience among metabolic complication, in contrast with the adult population metabolic acidosis was more common than metabolic alkalosis. We found no case of citrate accumulation, even in those patient with hepatic failure.

Conclusions:

In our experience regional citrate anticoagulation with commercially available solutions was easy to apply, safe and effective in preventing circuit clotting. We conclude that regional citrate anticoagulation can be used for CKRT in children, even in the ones with very low body weight or with liver failure.