Durak Aslan Ayşen, Aydın Özge, Uçmak Hacer, Eyduran Eda, Havan Merve, Kendirli Tanıl
Department of Pediatric Critical Care, Ankara University School of Medicine, Ankara, Turkey.
Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey.
Pediatr Nephrol. 2025 Sep 8. doi: 10.1007/s00467-025-06937-5.
This retrospective, descriptive study, conducted in a single-center PICU from June 2014 to May 2023, aimed to analyze the efficacy of adjunctive regional citrate anticoagulation for continuous kidney replacement therapy (CKRT) circuits during extracorporeal membrane oxygenation (ECMO).
Patients were divided into two groups based on their CKRT anticoagulation strategy: those receiving regional citrate anticoagulation in addition to systemic heparin (UFH + RCA group) and those receiving only systemic heparin (UFH group). CKRT circuits were also classified as either UFH + RCA or UFH to analyze outcomes specific to each anticoagulation strategy. CKRT circuit lifespan estimation was calculated by dividing the total CKRT duration by the number of circuits used.
During the study period, 110 pediatric patients were treated with ECMO at our PICU. During ECMO, 64 (58.2%) of these patients required CKRT. Fluid overload and acute kidney injury were the primary indications for CKRT. While not statistically significant, the median estimate CKRT circuit lifespan was longer in the citrate group [84 (38.4-112.0)] than the heparin group [52 (12.0-408.0)]. Circuit changes due to clotting were significantly higher in the heparin group compared to the citrate group (58.1% vs. 31.7%, p = 0.00). Kaplan-Meier analysis revealed a statistically significant difference in the timing of clotting-related circuit changes, favoring UFH + RCA (p = 0.02).
To the best of our knowledge, our study represents the first comparison of UFH + RCA and UFH alone for CKRT in pediatric ECMO patients. Our findings suggest that using UFH + RCA might help the circuit last longer by decreasing changes caused by clotting. Prospective studies on this topic are needed.
本回顾性描述性研究于2014年6月至2023年5月在单中心儿科重症监护病房（PICU）进行，旨在分析体外膜肺氧合（ECMO）期间辅助性局部枸橼酸抗凝用于连续性肾脏替代治疗（CKRT）回路的疗效。
根据CKRT抗凝策略将患者分为两组：除全身肝素外还接受局部枸橼酸抗凝的患者（普通肝素+局部枸橼酸抗凝组）和仅接受全身肝素的患者（普通肝素组）。CKRT回路也分为普通肝素+局部枸橼酸抗凝或普通肝素，以分析每种抗凝策略的特定结果。CKRT回路寿命估计值通过将CKRT总持续时间除以使用的回路数量来计算。
在研究期间，我们PICU的110例儿科患者接受了ECMO治疗。在ECMO期间，这些患者中有64例（58.2%）需要进行CKRT。液体超负荷和急性肾损伤是CKRT的主要指征。虽然无统计学意义，但枸橼酸组的CKRT回路寿命估计值中位数[84（38.4-112.0）]长于肝素组[52（12.0-408.0）]。与枸橼酸组相比，肝素组因凝血导致的回路更换明显更多（58.1%对31.7%，p = 0.00）。Kaplan-Meier分析显示，在与凝血相关的回路更换时间上存在统计学显著差异，支持普通肝素+局部枸橼酸抗凝（p = 0.02）。
据我们所知，我们的研究是首次对儿科ECMO患者CKRT中普通肝素+局部枸橼酸抗凝与单纯普通肝素进行比较。我们的研究结果表明，使用普通肝素+局部枸橼酸抗凝可能通过减少凝血引起的变化来帮助回路持续更长时间。需要对此主题进行前瞻性研究。
