1. OUTCOMES OF REGIONAL CITRATE ANTICOAGULATION (RCA) IN PEDIARTIC CONTINUOUS RENAL REPLACEMENT THERAPY (pCRRT) IN A SINGLE CENTER
Issa Alhamoud, Diane Gollhofer, Raymond Quigley.
Division of Pediatric Nephrology
University of Texas Southwestern Medical Center, Children’s Medical Center, Dallas, Texas, United States
I have no conflict of interests to resolve or disclose

2. Introduction: Objective:
The efficacy of Continuous Renal Replacement Therapy (CRRT) in critically sick children is dependent largely on the anticoagulation of circuit.
Systemic heparin.
Regional citrate anticoagulation (RCA).
Objective:
Circuit lifetime with regional citrate anticoagulation versus systemic heparin.
Circuit lifetime with RCA X1 (ml/hr) of blood flow rate (BFR) (ml/min) versus RCA X1.5 (ml/hr) of BFR (ml/min).
Correlation between circuit ionized calcium and circuit lifetime.

3. Methods Retrospective study:
Inclusion Criteria: All patients (1 day-21 years) who required CRRT>48 hours using either CVVH or CVVHDF including ECMO patients between Jan 2013-Dec 2016.
Exclusion criteria: CRRT<48 hrs or CRRT without anticoagulation.
Parameters:
Circuit lifetime (hrs): RCA vs Heparin and RCA X1 of BFR vs RCA X1.5 of BFR.
Mean circuit iCa for each circuit in citrate group.
CRRT Protocol:
BFR
ACD-A
CaCl 0.8%
Heparin
Dialysate
Filter
2-12 ml/kg/min, rarely >150 ml/min
1.5X BFR (ml/hr)
1X BFR (ml/hr)
Circuit iCa ( mmol/l)
0.4X BFR
(ml/hr)
0.3X BFR(ml/hr)
Pt iCa( mmol/l
Bolus:
10 units/kg
Maintenance: u/kg/hr
ACTs( )
2000 ml/1.73m²/hr.
RCA: Ca-free
HF1000
(1.1 m²)

4. Results Citrate Heparin P Patients number N=60 N=67 Age (Mon)(IQR)
126 (36-180)
60 (12-132)
0.004
Weight (kg)(IQR)
28 (17-57)
19(9.4-52)
0.011
Diagnosis
Sepsis
Malignancy/Sepsis
BMT/Sepsis
CHD
Liver disease
AKI/ESRD
Drug ingestion
Trauma 11 13 5 7 6 1 4 14 24 9
Mortality
23(38%)
28(41%) NS
CRRT duration (hrs)
18670
12501
Filters number
337
258

6. Pt #:26
Circuits #: 149
T. duration: 8634 hrs
Pt #:34
Circuits #: 188
T. duration: hrs

8. Conclusions
Circuit lifetimes were longer in citrate-based anticoagulation as compared to systemic heparin.
RCA that started at infusion rate (ml/hr) equal to BFR (Qb) (ml/min) had similar hemofitler lifespan to RCA that started at infusion rate 1.5 times of BFR. This could decrease the cost of CRRT and potentially reduce the risk of citrate toxicity.
Circuit lifetime was negatively correlated with circuit ionized Calcium level