Effect of regional citrate anticoagulation vs systemic heparin anticoagulation during continuous kidney replacement therapy on dialysis filter life span and mortality among critically ill patients with acute kidney injury: a randomized clinical trial
| Autor: | Melanie Meersch, Carola Wempe, John A. Kellum, Christian Putensen, Bartosz Tyczynski, Joachim Gerss, Andreas Kortgen, Stefan Kluge, Peter Rosenberger, Michael Jahn, Patrick Meybohm, Ulrich Jaschinski, Onnen Moerer, Philipp Deetjen, Nils Mülling, Sean M. Bagshaw, Mira Küllmar, Thomas Dimski, Torsten Slowinski, Stefan Wirtz, Detlef Kindgen-Milles, Rich Investigators, Philipp Simon, Gernot Marx, Alexander Zarbock, Jens-Christian Schewe, Timo Brandenburger, Martin Mehrländer, Tim Philipp Simon, Dominik Jarczak, Marc Bodenstein |
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| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Male
Time Factors Continuous Renal Replacement Therapy Critical Illness medicine.medical_treatment Medizin Hemorrhage Kaplan-Meier Estimate Infections 01 natural sciences Citric Acid law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial Interquartile range law Germany medicine Humans 030212 general & internal medicine Renal replacement therapy 0101 mathematics Dialysis Original Investigation Aged Proportional Hazards Models medicine.diagnostic_test Heparin business.industry 010102 general mathematics Acute kidney injury Anticoagulants General Medicine Acute Kidney Injury medicine.disease 3. Good health Clinical trial Anesthesia Early Termination of Clinical Trials Calcium Female Partial Thromboplastin Time Hemodialysis business Filtration Partial thromboplastin time |
| Zdroj: | JAMA |
| Popis: | IMPORTANCE: Although current guidelines suggest the use of regional citrate anticoagulation (which involves the addition of a citrate solution to the blood before the filter of the extracorporeal dialysis circuit) as first-line treatment for continuous kidney replacement therapy in critically ill patients, the evidence for this recommendation is based on few clinical trials and meta-analyses. OBJECTIVE: To determine the effect of regional citrate anticoagulation, compared with systemic heparin anticoagulation, on filter life span and mortality. DESIGN, SETTING, AND PARTICIPANTS: A parallel-group, randomized multicenter clinical trial in 26 centers across Germany was conducted between March 2016 and December 2018 (final date of follow-up, January 21, 2020). The trial was terminated early after 596 critically ill patients with severe acute kidney injury or clinical indications for initiation of kidney replacement therapy had been enrolled. INTERVENTIONS: Patients were randomized to receive either regional citrate anticoagulation (n = 300), which consisted of a target ionized calcium level of 1.0 to 1.40 mg/dL, or systemic heparin anticoagulation (n = 296), which consisted of a target activated partial thromboplastin time of 45 to 60 seconds, for continuous kidney replacement therapy. MAIN OUTCOMES AND MEASURES: Coprimary outcomes were filter life span and 90-day mortality. Secondary end points included bleeding complications and new infections. RESULTS: Among 638 patients randomized, 596 (93.4%) (mean age, 67.5 years; 183 [30.7%] women) completed the trial. In the regional citrate group vs systemic heparin group, median filter life span was 47 hours (interquartile range [IQR], 19-70 hours) vs 26 hours (IQR, 12-51 hours) (difference, 15 hours [95% CI, 11 to 20 hours]; P |
| Databáze: | OpenAIRE |
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