Regional citrate anticoagulation significantly reduced the hazard of filter clotting compared with heparin (aHR for heparin vs. RCA 1.78; 95% CI 1.14-2.77; p=0.011).
Cohort (n=420)
No
Does regional citrate anticoagulation reduce filter clotting in critically ill patients undergoing continuous renal replacement therapy compared to heparin?
Regional citrate anticoagulation improves filter survival compared to heparin during continuous renal replacement therapy, with its effectiveness heavily dependent on implementation fidelity such as timely post-filter ionized calcium monitoring.
Effect estimate: aHR 1.78 (95% CI 1.14-2.77)
p-value: p=0.011
Continuous renal replacement therapy (CRRT) is widely used in critically ill patients, but filter clotting remains a common complication. Regional citrate anticoagulation (RCA) is recommended; however, its real-world effectiveness may depend on implementation quality. This single-center retrospective cohort study analyzed 420 CRRT sessions from 1 September 2025 to 30 November 2025. Mixed-effects Cox models with patient-level random intercepts and competing-risk analysis were used. The primary outcome was filter clotting. In adjusted analyses, RCA was associated with a significantly reduced hazard of filter clotting compared with heparin (adjusted hazard ratio (aHR) for heparin vs. RCA: 1.78, 95% confidence interval (CI): 1.14-2.77, p = 0.011). Nafamostat showed no statistically significant difference from RCA (aHR: 1.31, 95% CI: 0.78-2.19, p = 0.31); however, the wide CI reflects limited sample size, and equivalence cannot be inferred. Within the RCA group, absence of timely post-filter ionized calcium (iCa2+) monitoring within 2 h was independently associated with increased clotting risk (adjusted odds ratio: 2.18, 95% CI: 1.24-3.84, p = 0.007), with a dose-response relationship (each one-hour delay increased clotting odds by 15%, p = 0.02). Major bleeding was infrequent (2.1% overall); metabolic complications (citrate accumulation) occurred in 2.9% of RCA sessions. In this cluster-adjusted real-world cohort, RCA was associated with improved filter survival compared with heparin. Implementation fidelity, particularly timely post-filter iCa2+ monitoring, appears to influence RCA effectiveness.
Ou et al. (Wed,) conducted a cohort in Critically ill patients requiring continuous renal replacement therapy (n=420). Regional citrate anticoagulation (RCA) vs. Heparin and nafamostat was evaluated on Filter clotting (aHR 1.78, 95% CI 1.14-2.77, p=0.011). Regional citrate anticoagulation significantly reduced the hazard of filter clotting compared with heparin (aHR for heparin vs. RCA 1.78; 95% CI 1.14-2.77; p=0.011).