Regional citrate versus heparin anticoagulation for continuous renal replacement therapy in critically ill patients: A meta-analysis of randomized controlled trials

Introduction This study aimed to compare the efficacy and safety of citrate and heparin in continuous renal replacement therapy (CRRT) for critically ill patients. Methods Searched in PubMed, Embase, and Cochrane Library databases. Results Analyses showed that there no difference existed in mortality, metabolic alkalosis, circuit loss, and the number of transfused between the two groups (RR = 0.95, p = 0.40; RR = 1.73, p = 0.40; RR = 0.64, p = 0.09; RR = 1.05, p = 0.70). The filter life of the citrate group was longer than the heparin group (MD = 16.98, p < 0.0001). The risk of bleeding and heparin-induced thrombocytopenia was significantly lower in the citrate (RR = 0.32, p < 0.00001; RR = 0.55, p = 0.04). The citrate group was more susceptible to hypocalcemia (RR = 4.85, p = 0.0004). Conclusion Citrate anticoagulant therapy should have priority for CRRT in most critically ill patients.

Automated summary

This study compared the efficacy and safety of citrate and heparin in continuous renal replacement therapy (CRRT) for critically ill patients. The analysis showed that citrate had a longer filter life and a lower risk of bleeding and heparin-induced thrombocytopenia compared to heparin. Citrate anticoagulant therapy should be the preferred choice for CRRT in most critically ill patients.