SCCM Podcast SCCM Pod-494: Mastering CRRT: Optimal Anticoagulation and Citrate Selection
Oct 5, 2023
Rajesh Speer, a pharmacist and nephrology research specialist, shares his expertise on continuous renal replacement therapy (CRRT) and anticoagulation strategies. He emphasizes the difference between citrate and heparin, showcasing citrate's benefits in minimizing bleeding risks. The discussion touches on the importance of balancing anticoagulation for circuits and patients, and highlights the challenges of compounding citrate versus using commercially available options. With practical insights, Speer advocates for standardized protocols to improve CRRT outcomes in critical care settings.
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Continuous Therapy Must Run Uninterrupted
- Continuous renal replacement therapy (CRRT) must run uninterrupted to deliver intended clearance and benefit.
- Circuit clotting reduces delivered dose by about 20–30%, undermining therapy effectiveness.
Circuit Life Drives Delivered Dose
- One major cause of reduced delivered dose is shortened circuit life from clotting or inadequate anticoagulation.
- Extending circuit life preserves prescribed clearance and patient benefit.
Prefer Circuit-Only Anticoagulation
- Use anticoagulation that anticoagulates the circuit but not the patient to minimize bleeding risk.
- Favor options that prolong filter life while avoiding systemic anticoagulation in unstable ICU patients.