Adverse events with regional citrate anticoagulation versus heparin anticoagulation during continuous renal replacement therapy: a systematic review and trial sequential analysis

Abstract

Objective To compare adverse events (AEs) of regional citrate anticoagulation (RCA) versus heparin anticoagulation during continuous renal replacement therapy (CRRT) through systematic review and trial sequential analysis. Methods Based upon the relevant randomized control trials (RCT) comparing RCA and heparin anticoagulation during CRRT in both domestic and foreign databases, the authors re-analyzed various AEs including at least one of the following episodes: hypocalcemia, metabolic acidosis, metabolic alkalosis, hemorrhage and heparin-induced thrombocytopenia (HIT). Meta-analysis was performed with Revman 5.2 and TSA 0.9 software for trial sequential analysis (TSA). Results Among a total of 791 items, 18 articles were included. As compared with heparin, RCA lowered the frequency of overall AEs (RR=0.54, 95%CI:0.35-0.82, P=0.004). And hemorrhagic risk dropped by 73% (RR=0.27, 95%CI:0.19-0.38, P<0.001). The above findings were further confirmed by TSA analysis. Conclusions As compared with heparin, the risks for overall AEs with RCA decline significantly. RCA is thus superior to heparin in term of anticoagulation safety during CRRT. However, therapeutic protocols of RCA should be further optimized.

Keywords

• continuous renal replacement therapy
• regional citrate anticoagulation
• heparin