Effect of citrate on the coagulation system in patients receiving CRRT
Research type
Research Study
Full title
The effect of regional citrate anti-coagulation on the coagulation system in critically ill patients receiving continuous renal replacement therapy for acute kidney injury.
IRAS ID
143534
Contact name
Marlies Ostermann
Contact email
Sponsor organisation
Guy's and St Thomas' NHS Foundation Trust
Research summary
Haemodialysis is frequently used in critical care when patients have an acute kidney injury such that their own kidneys are no longer able to sufficiently remove water and/or solutes from the body. Haemodialysis usually involves two plastic catheters being inserted in to the patient’s vein, such that their blood can be removed from the body, dialysed and then returned to their circulation. Whenever the patient’s blood comes in contact with a foreign surface (the dialysis equipment) a cascade of reactions begin to take place, causing the blood to clot. Clotting of the blood within the dialysis equipment leads to decreased dialysis efficiency, loss of the patients blood to clotted dialysis filters which need to be discarded and increased expense as more dialysis sets need to be used. For this reason it is necessary to add to the blood a drug which decreases the bloods tendency to clot. Regional anti-coagulation with citrate is becoming increasingly popular in intensive care units, as anti-coagulation is felt to be limited to the dialysis circuit and provides a greater duration of dialysis, as the dialysis filters are less prone to clotting (and dialysis is therefore less frequently interrupted to change the dialysis circuit).
From our experience we know that some patients experience clotting within the dialysis equipment prematurely (in our own audit ~18% of circuits clotted within 24 hours) despite adequate reduction in ionised calcium levels. It is hoped that if we describe the effect of citrate on the clotting pathway we might subsequently be able to investigate why some patients experience premature clotting within the filter.
REC name
London - Harrow Research Ethics Committee
REC reference
14/LO/0138
Date of REC Opinion
18 Mar 2014
REC opinion
Further Information Favourable Opinion