Clinical review: Anticoagulation for continuous renal replacement therapy - heparin or citrate?

Critical Care

Volumn 15, Issue 1, 2010, Pages

  Oudemans van Straaten, Heleen M ^a   Kellum, John A ^b   Bellomo, Rinaldo ^c  

^a ONZE LIEVE VROUWE GASTHUIS   (Netherlands)

^b UNIVERSITY OF PITTSBURGH SCHOOL OF MEDICINE   (United States)

^c AUSTIN HOSPITAL   (Australia)

Author keywords

[No Author keywords available]

Indexed keywords

ANTITHROMBIN; BICARBONATE; CALCIUM; CITRIC ACID; HEPARIN; NADROPARIN;

ACUTE KIDNEY FAILURE; ANTICOAGULATION; APOPTOSIS; BLEEDING; CLINICAL TRIAL; CRITICALLY ILL PATIENT; DRUG COST; DRUG EFFICACY; DRUG RECEPTOR BINDING; DRUG SAFETY; DRUG USE; ENERGY; HEMODIALYSIS; HUMAN; METABOLIC ACIDOSIS; METABOLIC ALKALOSIS; METABOLIC DISORDER; MICROCIRCULATION; MITOCHONDRION; NECROSIS; PHAGOCYTOSIS; PRIORITY JOURNAL; RENAL REPLACEMENT THERAPY; REVIEW; RISK; SEPSIS; SURVIVAL; THROMBOCYTOPENIA;

EID: 84856253734     PISSN: 13648535     EISSN: 1466609X     Source Type: Journal    
DOI: 10.1186/cc9358     Document Type: Review

References (66)

1. Uchino S, Bellomo R, Morimatsu H, Morgera S, Schetz M, Tan I, Bouman C, Macedo E, Gibney N, Tolwani A, Oudemans-van Straaten H, Ronco C, Kellum JA. Continuous renal replacement therapy: a worldwide practice survey. The beginning and ending supportive therapy for the kidney (B.E.S.T. kidney) investigators. Intensive Care Med 2007, 33:1563-1570. 10.1007/s00134-007-0754-4, 17594074.
2. Hirsh J, Warkentin TE, Shaughnessy SG, Anand SS, Halperin JL, Raschke R, Granger C, Ohman EM, Dalen JE. Heparin and low-molecular-weight heparin: mechanisms of action, pharmacokinetics, dosing, monitoring, efficacy, and safety. Chest 2001, 119:64S-94S. 10.1378/chest.119.1_suppl.64S, 11157643.
3. Cohen JR, Sarfati I, Birnbaum E, Benacquista T, Wise L. The inactivation of antithrombin III by serum elastase in patients with surgical infections. Am Surg 1990, 56:665-667.
4. Jordan RE, Nelson RM, Kilpatrick J, Newgren JO, Esmon PC, Fournel MA. Antithrombin inactivation by neutrophil elastase requires heparin. Am J Med 1989, 87:19S-22S. 10.1016/0002-9343(89)80526-1, 2690610.
5. Manson L, Weitz JI, Podor TJ, Hirsh J, Young E. The variable anticoagulant response to unfractionated heparin in vivo reflects binding to plasma proteins rather than clearance. J Lab Clin Med 1997, 130:649-655. 10.1016/S0022-2143(97)90115-3, 9422339.
6. Liu S, Hoke D, Julian J, Carson DD. Heparin/heparan sulfate (HP/HS) interacting protein (HIP) supports cell attachment and selective, high affinity binding of HP/HS. J Biol Chem 1997, 272:25856-25862. 10.1074/jbc.272.41.25856, 9325317.
7. Young E, Podor TJ, Venner T, Hirsh J. Induction of the acute-phase reaction increases heparin-binding proteins in plasma. Arterioscler Thromb Vasc Biol 1997, 17:1568-1574.
8. Cosmi B, Fredenburgh JC, Rischke J, Hirsh J, Young E, Weitz JI. Effect of nonspecific binding to plasma proteins on the antithrombin activities of unfractionated heparin, low-molecular-weight heparin, and dermatan sulfate. Circulation 1997, 95:118-124.
9. Hochart H, Jenkins PV, Preston RJ, Smith OP, White B, O'Donnell J. Concentration-dependent roles for heparin in modifying lipopolysaccharide-induced activation of mononuclear cells in whole blood. Thromb Haemost 2008, 99:570-575.
10. Gebska MA, Titley I, Paterson HF, Morilla RM, Davies DC, Gruszka-Westwood AM, Kakkar VV, Eccles S, Scully MF. High-affinity binding sites for heparin generated on leukocytes during apoptosis arise from nuclear structures segregated during cell death. Blood 2002, 99:2221-2227. 10.1182/blood.V99.6.2221, 11877301.
11. Oudemans-Van Straaten HM, van SM, Molenaar PJ, Wester JP, Leyte A. Hemostasis during low molecular weight heparin anticoagulation for continuous venovenous hemofiltration: a randomized cross-over trial comparing two hemofiltration rates. Crit Care 2009, 13:R193. 10.1186/cc8191, 2811918, 19958532.
12. van de Wetering J, Westendorp RG, van der Hoeven JG, Stolk B, Feuth JD, Chang PC. Heparin use in continuous renal replacement procedures: the struggle between filter coagulation and patient hemorrhage. J Am Soc Nephrol 1996, 7:145-150.
13. Oudemans-Van Straaten HM, Wester JP, de Pont AC, Schetz MR. Anticoagulation strategies in continuous renal replacement therapy: can the choice be evidence based?. Intensive Care Med 2006, 32:188-202. 10.1007/s00134-005-0044-y, 16453140.
14. Carr JA, Silverman N. The heparin-protamine interaction. A review. J Cardiovasc Surg (Torino) 1999, 40:659-666.
15. Warren BL, Eid A, Singer P, Pillay SS, Carl P, Novak I, Chalupa P, Atherstone A, Penzes I, Kubler A, Knaub S, Keinecke HO, Heinrichs H, Schindel F, Juers M, Bone RC, Opal SM. Caring for the critically ill patient. High-dose antithrombin III in severe sepsis: a randomized controlled trial. JAMA 2001, 286:1869-1878. 10.1001/jama.286.15.1869, 11597289.
16. Leithauser B, Schumacher J, Lendemans S, Tillmanns H, Matthias FR. Antithrombin attenuates microvascular leakage and leukocyte- endothelial interaction in response to endotoxin. Semin Thromb Hemost 2002, 28(Suppl 1):87-94. 10.1055/s-2002-30201, 12016584.
17. Hoffmann JN, Vollmar B, Laschke MW, Inthorn D, Kaneider NC, Dunzendorfer S, Wiedermann CJ, Romisch J, Schildberg FW, Menger MD. Adverse effect of heparin on antithrombin action during endotoxemia: microhemodynamic and cellular mechanisms. Thromb Haemost 2002, 88:242-252.
18. Heinzelmann M, Bosshart H. Heparin binds to lipopolysaccharide (LPS)-binding protein, facilitates the transfer of LPS to CD14, and enhances LPS-induced activation of peripheral blood monocytes. J Immunol 2005, 174:2280-2287.
19. Borawski J. Myeloperoxidase as a marker of hemodialysis biocompatibility and oxidative stress: the underestimated modifying effects of heparin. Am J Kidney Dis 2006, 47:37-41. 10.1053/j.ajkd.2005.10.001, 16377383.
20. Gritters M, Borgdorff P, Grooteman MP, Schoorl M, Schoorl M, Bartels PC, Tangelder GJ, Nube MJ. Platelet activation in clinical haemodialysis: LMWH as a major contributor to bio-incompatibility?. Nephrol Dial Transplant 2008, 23:2911-2917. 10.1093/ndt/gfn137, 18364368.
21. Myrup B, Yokoyama H, Kristiansen OP, Ostergaard PB, Olivecrona T. Release of endothelium-associated proteins into blood by injection of heparin in normal subjects and in patients with type 1 diabetes. Diabet Med 2004, 21:1135-1140. 10.1111/j.1464-5491.2004.01313.x, 15384962.
22. Tasaki H, Yamashita K, Tsutsui M, Kamezaki F, Kubara T, Tanaka S, Sasaguri Y, Adachi T, Nakashima Y. Heparin-released extracellular superoxide dismutase is reduced in patients with coronary artery atherosclerosis. Atherosclerosis 2006, 187:131-138. 10.1016/j.atherosclerosis.2005.08.028, 16191429.
23. Cornet AD, Smit EG, Beishuizen A, Groeneveld AB. The role of heparin and allied compounds in the treatment of sepsis. Thromb Haemost 2007, 98:579-586.
24. Levi M, van der Poll T. Inflammation and coagulation. Crit Care Med 2010, 38:S26-S34. 10.1097/CCM.0b013e3181c98d21, 20083910.
25. Black SC, Gralinski MR, Friedrichs GS, Kilgore KS, Driscoll EM, Lucchesi BR. Cardioprotective effects of heparin or N-acetylheparin in an in vivo model of myocardial ischaemic and reperfusion injury. Cardiovasc Res 1995, 29:629-636.
26. Wang L, Brown JR, Varki A, Esko JD. Heparin's anti-inflammatory effects require glucosamine 6-O-sulfation and are mediated by blockade of L-and P-selectins. J Clin Invest 2002, 110:127-136. 151027, 12093896.
27. Thourani VH, Brar SS, Kennedy TP, Thornton LR, Watts JA, Ronson RS, Zhao ZQ, Sturrock AL, Hoidal JR, Vinten-Johansen J. Nonanticoagulant heparin inhibits NF-κB activation and attenuates myocardial reperfusion injury. Am J Physiol Heart Circ Physiol 2000, 278:H2084-H2093.
28. Hoffmann JN, Hartl WH, Faist E, Jochum M, Inthorn D. Tumor necrosis factor measurement and use of different anticoagulants: possible interference in plasma samples and supernatants from endotoxin-stimulated monocytes. Inflamm Res 1997, 46:342-347. 10.1007/s000110050199, 9339389.
29. Leitienne P, Fouque D, Rigal D, Adeleine P, Trzeciak MC, Laville M. Heparins and blood polymorphonuclear stimulation in haemodialysis: an expansion of the biocompatibility concept. Nephrol Dial Transplant 2000, 15:1631-1637. 10.1093/ndt/15.10.1631, 11007833.
30. Warkentin TE. Heparin-induced thrombocytopenia: diagnosis and management. Circulation 2004, 110:e454-e458. 10.1161/01.CIR.0000147537.72829.1B, 15520327.
31. Verma AK, Levine M, Shalansky SJ, Carter CJ, Kelton JG. Frequency of heparin-induced thrombocytopenia in critical care patients. Pharmacotherapy 2003, 23:745-753. 10.1592/phco.23.6.745.32188, 12820817.
32. Selleng K, Warkentin TE, Greinacher A. Heparin-induced thrombocytopenia in intensive care patients. Crit Care Med 2007, 35:1165-1176. 10.1097/01.CCM.0000259538.02375.A5, 17334253.
33. Selleng S, Selleng K, Wollert HG, Muellejans B, Lietz T, Warkentin TE, Greinacher A. Heparin-induced thrombocytopenia in patients requiring prolonged intensive care unit treatment after cardiopulmonary bypass. J Thromb Haemost 2008, 6:428-435. 10.1111/j.1538-7836.2007.02870.x, 18088340.
34. Oudemans-Van Straaten HM. Anticoagulation for renal replacement therapy: heparin or citrate. Controversies in Intensive Care Medicine 2008, 153-161. Berlin: Medizinische Wissenschaftliche Verlagsgesellschaft, Kuhlen R, Moreno R, Ranieri M, Rhodes A.
35. Oudemans-Van Straaten HM, Bosman RJ, Koopmans M, van der Voort PH, Wester JP, van der Spoel JI, Dijksman LM, Zandstra DF. Citrate anticoagulation for continuous venovenous hemofiltration. Crit Care Med 2009, 37:545-552. 10.1097/CCM.0b013e3181953c5e, 19114912.
36. Swartz R, Pasko D, O'Toole J, Starmann B. Improving the delivery of continuous renal replacement therapy using regional citrate anticoagulation. Clin Nephrol 2004, 61:134-143.
37. Oudemans-Van Straaten HM. Citrate anticoagulation for continuous renal replacement therapy in the critically ill. Blood Purif 2010, 29:191-196. 10.1159/000245646, 20093826.
38. Joannidis M, Oudemans-Van Straaten HM. Clinical review: Patency of the circuit in continuous renal replacement therapy. Crit Care 2007, 11:218. 10.1186/cc5937, 2206533, 17634148.
39. Morgan TJ. The Stewart approach - one clinician's perspective. Clin Biochem Rev 2009, 30:41-54. 2702213, 19565024.
40. Egi M, Naka T, Bellomo R, Cole L, French C, Trethewy C, Wan L, Langenberg CC, Fealy N, Baldwin I. A comparison of two citrate anticoagulation regimens for continuous veno-venous hemofiltration. Int J Artif Organs 2005, 28:1211-1218.
41. Apsner R, Schwarzenhofer M, Derfler K, Zauner C, Ratheiser K, Kranz A. Impairment of citrate metabolism in acute hepatic failure. Wien Klin Wochenschr 1997, 109:123-127.
42. Kramer L, Bauer E, Joukhadar C, Strobl W, Gendo A, Madl C, Gangl A. Citrate pharmacokinetics and metabolism in cirrhotic and noncirrhotic critically ill patients. Crit Care Med 2003, 31:2450-2455. 10.1097/01.CCM.0000084871.76568.E6, 14530750.
43. Meier-Kriesche HU, Gitomer J, Finkel K, DuBose T. Increased total to ionized calcium ratio during continuous venovenous hemodialysis with regional citrate anticoagulation. Crit Care Med 2001, 29:748-752. 10.1097/00003246-200104000-00010, 11373461.
44. Bakker AJ, Boerma EC, Keidel H, Kingma P, van der Voort PH. Detection of citrate overdose in critically ill patients on citrate-anticoagulated venovenous haemofiltration: use of ionised and total/ionised calcium. Clin Chem Lab Med 2006, 44:962-966. 10.1515/CCLM.2006.164, 16879061.
45. Hetzel GR, Taskaya G, Sucker C, Hennersdorf M, Grabensee B, Schmitz M. Citrate plasma levels in patients under regional anticoagulation in continuous venovenous hemofiltration. Am J Kidney Dis 2006, 48:806-811. 10.1053/j.ajkd.2006.07.016, 17060000.
46. Bohler J, Schollmeyer P, Dressel B, Dobos G, Horl WH. Reduction of granulocyte activation during hemodialysis with regional citrate anticoagulation: dissociation of complement activation and neutropenia from neutrophil degranulation. J Am Soc Nephrol 1996, 7:234-241.
47. Bohler J, Donauer J, Birmelin M, Schollmeyer PJ, Horl WH. Mediators of complement-independent granulocyte activation during haemodialysis: role of calcium, prostaglandins and leukotrienes. Nephrol Dial Transplant 1993, 8:1359-1365.
48. Andersson T, Dahlgren C, Pozzan T, Stendahl O, Lew PD. Characterization of fMet-Leu-Phe receptor-mediated Ca2+ influx across the plasma membrane of human neutrophils. Mol Pharmacol 1986, 30:437-443.
49. Lew PD, Wollheim CB, Waldvogel FA, Pozzan T. Modulation of cytosolic-free calcium transients by changes in intracellular calcium-buffering capacity: correlation with exocytosis and O2-production in human neutrophils. J Cell Biol 1984, 99:1212-1220. 10.1083/jcb.99.4.1212, 2113305, 6090467.
50. Haag-Weber M, Mai B, Deppisch R, Gohl H, Horl WH. Studies of biocompatibility of different dialyzer membranes: role of complement system, intracellular calcium and inositol-triphosphate. Clin Nephrol 1994, 41:245-251.
51. Dhondt A, Vanholder R, Tielemans C, Glorieux G, Waterloos MA, De Smet R, Lameire N. Effect of regional citrate anticoagulation on leukopenia, complement activation, and expression of leukocyte surface molecules during hemodialysis with unmodified cellulose membranes. Nephron 2000, 85:334-342. 10.1159/000045683, 10940744.
52. Gabutti L, Ferrari N, Mombelli G, Keller F, Marone C. The favorable effect of regional citrate anticoagulation on interleukin-1β release is dissociated from both coagulation and complement activation. J Nephrol 2004, 17:819-825.
53. Polanska K, Opatrny K, Rokyta R, Krouzecky A, Vit L, Kasal E. Effect of regional citrate anticoagulation on thrombogenicity and biocompatibility during CVVHDF. Ren Fail 2006, 28:107-118. 10.1080/08860220500530338, 16538967.
54. Bos JC, Grooteman MP, van Houte AJ, Schoorl M, van Limbeek J, Nube MJ. Low polymorphonuclear cell degranulation during citrate anticoagulation: a comparison between citrate and heparin dialysis. Nephrol Dial Transplant 1997, 12:1387-1393. 10.1093/ndt/12.7.1387, 9249774.
55. Food energy - methods of analysis and conversion factors. FAO Food and Nutrition Paper 77. , ftp://ftp.fao.org/docrep/fao/006/y5022e/y5022e00.pdf
56. Citric acid. , http://www.ecama.org/level_2/SDS/1CAM22April1998.doc
57. Balik M, Zakharchenko M, Otahal M, Hruby J, Rusinova K, Polak F, Stach Z, Vavrova J, Jabor A. Quantification of systemic dose of substrates for intermediate metabolism during citrate anticoagulation of continous renal replacement therapy. Intensive Care Med 2010, 36:S293.
58. Vary TC, Hazen SA, Maish G, Cooney RN. TNF binding protein prevents hyperlactatemia and inactivation of PDH complex in skeletal muscle during sepsis. J Surg Res 1998, 80:44-51. 10.1006/jsre.1998.5324, 9790813.
59. Weinberg JM, Venkatachalam MA, Roeser NF, Nissim I. Mitochondrial dysfunction during hypoxia/reoxygenation and its correction by anaerobic metabolism of citric acid cycle intermediates. Proc Natl Acad Sci USA 2000, 97:2826-2831. 10.1073/pnas.97.6.2826, 16014, 10717001.
60. Feldkamp T, Weinberg JM, Horbelt M, Von Kropff C, Witzke O, Nurnberger J, Kribben A. Evidence for involvement of nonesterified fatty acid-induced protonophoric uncoupling during mitochondrial dysfunction caused by hypoxia and reoxygenation. Nephrol Dial Transplant 2009, 24:43-51. 10.1093/ndt/gfn436, 2721422, 18678559.
61. Ward DM, Mehta RL. Extracorporeal management of acute renal failure patients at high risk of bleeding. Kidney Int Suppl 1993, 41:S237-S244.
62. van der Voort PH, Postma SR, Kingma WP, Boerma EC, Van Roon EN. Safety of citrate based hemofiltration in critically ill patients at high risk for bleeding: a comparison with nadroparin. Int J Artif Organs 2006, 29:559-563.
63. Monchi M, Berghmans D, Ledoux D, Canivet JL, Dubois B, Damas P. Citrate vs. heparin for anticoagulation in continuous venovenous hemofiltration: a prospective randomized study. Intensive Care Med 2004, 30:260-265. 10.1007/s00134-003-2047-x, 14600809.
64. Kutsogiannis DJ, Gibney RT, Stollery D, Gao J. Regional citrate versus systemic heparin anticoagulation for continuous renal replacement in critically ill patients. Kidney Int 2005, 67:2361-2367. 10.1111/j.1523-1755.2005.00342.x, 15882280.
65. Betjes MG, van Oosterom D, van Agteren M, van de WJ. Regional citrate versus heparin anticoagulation during venovenous hemofiltration in patients at low risk for bleeding: similar hemofilter survival but significantly less bleeding. J Nephrol 2007, 20:602-608.
66. Hetzel GR, Schmitz M, Wissing H, Ries W, Schott G, Heering PJ, Isgro F, Kribben A, Himmele R, Grabensee B, Rump LC. Regional citrate versus systemic heparin for anticoagulation in critically ill patients on continuous venovenous haemofiltration: a prospective randomized multicentre trial. Nephrol Dial Transplant 2010, 26:232-239. 10.1093/ndt/gfq575, 20876598.