Clinical application of regional citrate anticoagulation for continuous renal replacement therapy in children with liver injury

作者全名："Hu, Fang; Sun, Yuelin; Bai, Ke; Liu, Chengjun"

作者地址："[Hu, Fang; Sun, Yuelin; Bai, Ke; Liu, Chengjun] Chongqing Med Univ, Intens Care Unit, Minist Educ Key Lab Children Dev & Disorders, Chongqing Key Lab Pediat,Childrens Hosp,China Int, Chongqing, Peoples R China; [Hu, Fang] Peoples Hosp Qijiang Dist, Chongqing, Peoples R China"

通信作者："Bai, K (通讯作者)，Chongqing Med Univ, Intens Care Unit, Minist Educ Key Lab Children Dev & Disorders, Chongqing Key Lab Pediat,Childrens Hosp,China Int, Chongqing, Peoples R China."

来源：FRONTIERS IN PEDIATRICS

ESI学科分类：CLINICAL MEDICINE

WOS号：WOS:000876194100001

JCR分区：Q1

影响因子：2.6

年份：2022

卷号：10

期号：　

开始页：　

结束页：　

文献类型：Article

关键词：children; liver injury; liver failure; regional citrate anticoagulation; continuous renal replacement therapy

摘要："BackgroundRegional citrate anticoagulation (RCA) is increasingly used for continuous renal replacement therapy (CRRT) in children, but it is rarely used in children with liver injury, especially liver failure (LF). We analyze this issue through the following research. MethodsWe retrospectively analyzed 75 children with liver injury who underwent RCA-CRRT in the Pediatric Intensive Care Unit (PICU) of Children's Hospital of Chongqing Medical University. The patients were divided into the LF group and liver dysfunction (LD) group. The two groups were compared to evaluate the clinical safety and efficacy of RCA-CRRT in children with liver injury and to explore RCA-CRRT management strategies, in terms of the following indicators: the incidence of bleeding, clotting, citrate accumulation (CA), acid-base imbalance, and electrolyte disturbance, as well as filter lifespans, changes in biochemical indicators, and CRRT parameters adjustment. ResultsThe total incidence of CA (TCA) and persistent CA (PCA) in the LF group were significantly higher than those in the LD group (38.6 vs. 16.2%, p < 0.001; 8.4 vs. 1.5%, p < 0.001); and the CA incidence was significantly reduced after adjustment both in the LF (38.6 vs. 8.4%, p < 0.001) and LD groups (16.2 vs. 1.5%, p < 0.001). The incidence of hypocalcemia was significantly higher in the LF group than in the LD group either before (34.9 vs. 8.8%, p < 0.001) or after treatment (12.0 vs. 0%, p < 0.001). The speed of the blood and citrate pumps after adjustment was lower than the initial setting values in both the LF and LD groups. The dialysis speed plus replacement speed were higher than the initial settings parameters. ConclusionFor children undergoing RCA-CRRT, the risks of CA and hypocalcemia are significantly higher in children with liver failure than those with liver dysfunction, but through the proper adjustment of the protocol, RCA-CRRT can still be safely and effectively approached for children with LD and even LF."

基金机构：Program for Youth Innovation in Future Medicine from Chongqing Medical University: Basic and Clinical Study of Critical Illness in Children [2021-W0111]

基金资助正文：This work was supported by the Program for Youth Innovation in Future Medicine from Chongqing Medical University: Basic and Clinical Study of Critical Illness in Children (2021-W0111; Dang Hongxing).