Regional citrate anticoagulation (RCA) in critically ill patients undergoing renal replacement therapy (RRT): expert opinion from the SIAARTI-SIN joint commission
Abstract Renal replacement therapies (RRT) are essential to support critically ill patients with severe acute kidney injury (AKI), providing control of solutes, fluid balance and acid–base status. To maintain the patency of the extracorporeal circuit, minimizing downtime periods and blood losses due...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-03-01
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| Series: | Journal of Anesthesia, Analgesia and Critical Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s44158-023-00091-w |
| _version_ | 1797853516549586944 |
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| author | Valentina Pistolesi Santo Morabito Vincenzo Pota Fabrizio Valente Francesca Di Mario Enrico Fiaccadori Giacomo Grasselli Nicola Brienza Vincenzo Cantaluppi Silvia De Rosa Vito Fanelli Marco Fiorentino Marita Marengo Stefano Romagnoli the SIAARTI-SIN joint commission |
| author_facet | Valentina Pistolesi Santo Morabito Vincenzo Pota Fabrizio Valente Francesca Di Mario Enrico Fiaccadori Giacomo Grasselli Nicola Brienza Vincenzo Cantaluppi Silvia De Rosa Vito Fanelli Marco Fiorentino Marita Marengo Stefano Romagnoli the SIAARTI-SIN joint commission |
| author_sort | Valentina Pistolesi |
| collection | DOAJ |
| description | Abstract Renal replacement therapies (RRT) are essential to support critically ill patients with severe acute kidney injury (AKI), providing control of solutes, fluid balance and acid–base status. To maintain the patency of the extracorporeal circuit, minimizing downtime periods and blood losses due to filter clotting, an effective anticoagulation strategy is required. Regional citrate anticoagulation (RCA) has been introduced in clinical practice for continuous RRT (CRRT) in the early 1990s and has had a progressively wider acceptance in parallel to the development of simplified systems and safe protocols. Main guidelines on AKI support the use of RCA as the first line anticoagulation strategy during CRRT in patients without contraindications to citrate and regardless of the patient’s bleeding risk. Experts from the SIAARTI-SIN joint commission have prepared this position statement which discusses the use of RCA in different RRT modalities also in combination with other extracorporeal organ support systems. Furthermore, advise is provided on potential limitations to the use of RCA in high-risk patients with particular attention to the need for a rigorous monitoring in complex clinical settings. Finally, the main findings about the prospective of optimization of RRT solutions aimed at preventing electrolyte derangements during RCA are discussed in detail. |
| first_indexed | 2024-04-09T19:50:51Z |
| format | Article |
| id | doaj.art-62aed6e0b99c4b7db6d775686a91df66 |
| institution | Directory Open Access Journal |
| issn | 2731-3786 |
| language | English |
| last_indexed | 2024-04-09T19:50:51Z |
| publishDate | 2023-03-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Anesthesia, Analgesia and Critical Care |
| spelling | doaj.art-62aed6e0b99c4b7db6d775686a91df662023-04-03T05:44:20ZengBMCJournal of Anesthesia, Analgesia and Critical Care2731-37862023-03-013111410.1186/s44158-023-00091-wRegional citrate anticoagulation (RCA) in critically ill patients undergoing renal replacement therapy (RRT): expert opinion from the SIAARTI-SIN joint commissionValentina Pistolesi0Santo Morabito1Vincenzo Pota2Fabrizio Valente3Francesca Di Mario4Enrico Fiaccadori5Giacomo Grasselli6Nicola Brienza7Vincenzo Cantaluppi8Silvia De Rosa9Vito Fanelli10Marco Fiorentino11Marita Marengo12Stefano Romagnoli13the SIAARTI-SIN joint commissionUOSD Dialisi, Azienda Ospedaliero-Universitaria Policlinico Umberto I, “Sapienza” Università̀ di RomaUOSD Dialisi, Azienda Ospedaliero-Universitaria Policlinico Umberto I, “Sapienza” Università̀ di RomaDepartment of Women, Child, General and Specialistic Surgery, University of Campania “L. Vanvitelli”Nephrology and Dialysis Unit, Santa Chiara Regional Hospital, APSSUO Nefrologia, Azienda Ospedaliero-Universitaria Parma, Dipartimento di Medicina e Chirurgia, Università di ParmaUO Nefrologia, Azienda Ospedaliero-Universitaria Parma, Dipartimento di Medicina e Chirurgia, Università di ParmaDepartment of Anesthesia, Intensive Care and Emergency, Fondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoDepartment of Interdisciplinary Medicine, ICU Section, University of Bari “Aldo Moro”Nephrology and Kidney Transplantation Unit, Department of Translational Medicine (DIMET), University of Piemonte Orientale (UPO), AOU “Maggiore Della Carità”Centre for Medical Sciences-CISMed, University of TrentoDepartment of Surgical Sciences, University of TurinNephrology Dialysis and Transplantation Unit, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo MoroDepartment of Medical Specialist, Nephrology and Dialysis Unit, ASL CN1Section of Anesthesiology and Intensive Care, Department of Health Sciences, University of FlorenceAbstract Renal replacement therapies (RRT) are essential to support critically ill patients with severe acute kidney injury (AKI), providing control of solutes, fluid balance and acid–base status. To maintain the patency of the extracorporeal circuit, minimizing downtime periods and blood losses due to filter clotting, an effective anticoagulation strategy is required. Regional citrate anticoagulation (RCA) has been introduced in clinical practice for continuous RRT (CRRT) in the early 1990s and has had a progressively wider acceptance in parallel to the development of simplified systems and safe protocols. Main guidelines on AKI support the use of RCA as the first line anticoagulation strategy during CRRT in patients without contraindications to citrate and regardless of the patient’s bleeding risk. Experts from the SIAARTI-SIN joint commission have prepared this position statement which discusses the use of RCA in different RRT modalities also in combination with other extracorporeal organ support systems. Furthermore, advise is provided on potential limitations to the use of RCA in high-risk patients with particular attention to the need for a rigorous monitoring in complex clinical settings. Finally, the main findings about the prospective of optimization of RRT solutions aimed at preventing electrolyte derangements during RCA are discussed in detail.https://doi.org/10.1186/s44158-023-00091-wAKICitrateCRRTPIRRTRegional citrate anticoagulation |
| spellingShingle | Valentina Pistolesi Santo Morabito Vincenzo Pota Fabrizio Valente Francesca Di Mario Enrico Fiaccadori Giacomo Grasselli Nicola Brienza Vincenzo Cantaluppi Silvia De Rosa Vito Fanelli Marco Fiorentino Marita Marengo Stefano Romagnoli the SIAARTI-SIN joint commission Regional citrate anticoagulation (RCA) in critically ill patients undergoing renal replacement therapy (RRT): expert opinion from the SIAARTI-SIN joint commission Journal of Anesthesia, Analgesia and Critical Care AKI Citrate CRRT PIRRT Regional citrate anticoagulation |
| title | Regional citrate anticoagulation (RCA) in critically ill patients undergoing renal replacement therapy (RRT): expert opinion from the SIAARTI-SIN joint commission |
| title_full | Regional citrate anticoagulation (RCA) in critically ill patients undergoing renal replacement therapy (RRT): expert opinion from the SIAARTI-SIN joint commission |
| title_fullStr | Regional citrate anticoagulation (RCA) in critically ill patients undergoing renal replacement therapy (RRT): expert opinion from the SIAARTI-SIN joint commission |
| title_full_unstemmed | Regional citrate anticoagulation (RCA) in critically ill patients undergoing renal replacement therapy (RRT): expert opinion from the SIAARTI-SIN joint commission |
| title_short | Regional citrate anticoagulation (RCA) in critically ill patients undergoing renal replacement therapy (RRT): expert opinion from the SIAARTI-SIN joint commission |
| title_sort | regional citrate anticoagulation rca in critically ill patients undergoing renal replacement therapy rrt expert opinion from the siaarti sin joint commission |
| topic | AKI Citrate CRRT PIRRT Regional citrate anticoagulation |
| url | https://doi.org/10.1186/s44158-023-00091-w |
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