Evaluation of anticoagulant methods in newborns undergoing continuous renal replacement therapy: what is the optimum method?

UNLABELLED

Implementing continuous renal replacement therapy (CRRT) in neonates is technically challenging due to complexities with vascular access, the risk of hemodynamic instability, and the need for precise anticoagulation management. Regional citrate anticoagulation has been shown to manage bleeding risks more effectively than heparin; however, its use in neonates is controversial due to potential adverse effects. This study aimed to evaluate the association between anticoagulation methods and the incidence of complications in neonates undergoing CRRT. We conducted a retrospective analysis of neonates who underwent CRRT from July 2014 to July 2024. Pre-dialysis characteristics were evaluated in infants receiving regional citrate or heparin anticoagulation. Dialysis duration, filter lifespan, and dialysis-related complications were compared between the two anticoagulation regimens. A total of 27 patients who received CRRT were included in the study. There were no significant differences between the two groups regarding gestational age, birth weight, dialysis initiation day, dialysis indications, pre-dialysis organ failure, or dialysis methods employed (p > 0.05). Dialysis-related bleeding, blood product requirements, thermoregulatory disturbances, infections, inotrope requirements, electrolyte imbalances, and metabolic disturbances during dialysis were comparable between the two groups (p > 0.05). A total of 36 dialysis sessions were conducted over 653 h, with a longer filter lifespan in the regional citrate group compared to the heparin group [18 h (10-19 h) vs. 8 h (3-24 h), p = 0.02]. The mortality rates were comparable (p = 0.13).

CONCLUSION

The use of regional citrate as an anticoagulant in neonatal CRRT is a safe and effective alternative to heparin. It prolongs filter lifespan without increasing dialysis-related complications.

WHAT IS KNOWN

• Continuous renal replacement therapy (CRRT) has gained popularity in recent years; however, the need for anticoagulation presents a significant challenge in neonatal CRRT. • Regional citrate anticoagulation (RCA) has been shown to be more effective and safer than heparin, in adult and pediatric patients. Data on the comparative safety and efficacy of citrate versus heparin in neonates remain limited.

WHAT IS NEW

• RCA is a safe and effective alternative to systemic heparin anticoagulation in neonates undergoing CRRT. • RCA demonstrated a significant advantage in prolonging filter lifespan without increasing the risk of bleeding, metabolic complications, or mortality in neonatal CRRT.