Regional anticoagulation in renal replacement therapy

Continuous renal replacement therapy (CRRT) has become the standard treatment for acute kidney injury or severe metabolic derangement in the pediatric intensive care unit.Anticoagulation for circuit patency is the prerequisite during CRRT operation.Regional citrate anticoagulation for CRRT is more effective and safe than systemic or regional heparin.Regional citrate anticoagulation can decrease the risk of circuit loss and filter failure; furthermore, it is safer than systemic heparin anticoagulation for the reduction of bleeding risk.Complications of citrate anticoagulation(such as acid-base imbalance and electrolyte disturbances) can be avoided by using an appropriate protocol and regular monitoring.Therefore, citrate should be considered as the first choice for anticoagulation during CRRT in critically ill pediatric patients, and further studies are needed to evaluate the safety and efficacy of citrate anticoagulation in the pediatric population. Key words: Continuous renal replacement therapy; Citrate; Heparin; Regional anticoagulation