Journal Article

Safety and efficacy of regional citrate anticoagulation for continuous renal replacement therapy in liver failure patients: a systematic review and meta-analysis

Sun, Shiren, Bai, Ming, Chen, Xiangmei, Zhao, Lijuan, Zhang, Wei, Li, Lu, Yu, Yan

2019

Overview

Background Regional citrate anticoagulation (RCA) is a widely used strategy for continuous renal replacement therapy (CRRT). Most of the current guidelines recommend liver failure as one of the contraindications for citrate anticoagulation. However, some studies suggested that the use of citrate for CRRT in liver failure patients did not increase the risk of citrate-related complications. The purpose of this systematic review is to summarize the current evidences on the safety and efficacy of RCA for CRRT in liver failure patients. Methods We performed a comprehensive search on PubMed, Embase, and the Cochrane Library databases from the inception to March 1, 2018. Studies enrolled adult (age > 18 years) patients with various levels of liver dysfunction underwent RCA-CRRT were included in this systematic review. Results After the study screening, 10 observational studies with 1241 liver dysfunction patients were included in this systematic review. The pooled rate of citrate accumulation and bleeding was 12% [3%, 22%] and 5% [2%, 8%], respectively. Compared with the baseline data, the serum pH, bicarbonate, and base excess (BE), the rate of metabolic alkalosis, the serum ionized calcium (ionCa) and total calcium (totCa) level, and the ratio of total calcium/ionized calcium (totCa/ionCa) significantly increased at the end of observation. However, no significant increase was observed in serum citrate (MD − 65.82 [− 194.19, 62.55]), lactate (MD 0.49 [− 0.27, 1.26]) and total bilirubin concentration (MD 0.79 [− 0.70, 2.29]) at the end of CRRT. Compared with non-liver failure patients, the live failure patients showed no significant difference in the pH (MD − 0.04 [− 0.13, 0.05]), serum lactate level (MD 0.69 [− 0.26, 1.64]), and totCa/ionCa ratio (MD 0.03 [− 0.12, 0.18]) during CRRT. The median of mean filter lifespan was 55.9 h, with a range from 22.7 to 72 h. Conclusions Regional citrate anticoagulation seems to be a safe anticoagulation method in liver failure patients underwent CRRT and could yield a favorable filter lifespan. Closely monitoring the acid base status and electrolyte balance may be more necessary during RCA-CRRT in patients with liver failure.

• Publisher: BioMed Central,BioMed Central Ltd,BMC
• Subject: Acid-Base Equilibrium - drug effects / Adult / Alkalosis / Analysis / Anticoagulants / Anticoagulants - administration & dosage / Anticoagulants - adverse effects / Anticoagulants - therapeutic use / Anticoagulation / Bilirubin / Carbonates / Care and treatment / Citrate / Citric acid / Citric Acid - administration & dosage / Citric Acid - analysis / Citric Acid - therapeutic use / Complications and side effects / Continuous renal replacement therapy / Critical Care Medicine / Electrolytes / Emergency Medicine / Hemorrhage - prevention & control / Humans / Intensive / Lactates / Liver diseases / Liver failure / Liver Failure - drug therapy / Liver Failure - physiopathology / Medical research / Medicine / Medicine & Public Health / Methods / Patient outcomes / Renal replacement therapy / Renal Replacement Therapy - adverse effects / Renal Replacement Therapy - methods / Renal Replacement Therapy - standards