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Letter
Citrate versus heparin anticoagulation in paediatric continuous renal replacement therapy
  1. Meghan Roberts1,
  2. Kate Peace1,2,
  3. Patrick Davies1,
  4. Catarina Silvestre1,
  5. Dusan Raffaj1
  1. 1 Paediatric Critical Care Unit, Queen's Medical Centre Nottingham Children's Hospital, Nottingham, UK
  2. 2 Baxter Healthcare, Newbury, UK
  1. Correspondence to Dr Meghan Roberts; meghan.roberts{at}nhs.net

https://doi.org/10.1136/archdischild-2024-327024

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    We present our analysis of citrate versus heparin anticoagulation for children in two UK paediatric intensive care units undergoing continuous renal replacement therapy (CRRT). CRRT allows for slow fluid removal and electrolyte normalisation in critically ill children.1

    Preventing the circuit from clotting is challenging, and frequent interruptions of treatment reduce efficacy, increase instability and increase blood product requirement.1 2

    Anticoagulation is required to prevent extracorporeal circuit clotting and preserve filter longevity, with systemic heparin anticoagulation (SHA) and regional citrate anticoagulation (RCA) being the most common choices. In adults, RCA has been shown to be more effective than SHA in preventing filter clotting and reducing the risk of bleeding, without significantly increasing complications.3 4 CRRT in children is complicated by their relatively lower blood volume …

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    Footnotes

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    • Contributors Data collection—MR, KP and CS. Study conception—DR. Drafting of paper—MR. Analysis and paper editing—MR, KP, PD, CS and DR.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests KP worked at Nottingham Children's Hospital PCCU while the data were collected and the manuscript was written. She has since left and now works for Baxter UK.

    • Provenance and peer review Not commissioned; externally peer reviewed.