Anticoagulation Strategies for Continuous Renal Replacement Therapy in France: A Survey of Practices

Justine Pible; Frank Bidar; Nicolas Chardon; Valérie Cerro; Carole Ichai; Céline Monard; Antoine Schneider; Olivier Joannes-Boyau; Jean-Michel Constantin; Thomas Rimmelé

doi:10.1159/000540553

Anticoagulation Strategies for Continuous Renal Replacement Therapy in France: A Survey of Practices

Blood Purif. 2024 Sep 30:1-8. doi: 10.1159/000540553. Online ahead of print.

Authors

Affiliations

¹ Département d'Anesthésie-Réanimation, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France.
² EA 7426, Pathophysiology of Injury-Induced Immunosuppression, Hospices Civils de Lyon-Biomérieux-Université Claude Bernard Lyon 1, Lyon, France.
³ Département d'Anesthésie-Réanimation, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, Nice, France.
⁴ Service de Médecine Intensive Adulte, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.
⁵ Service d'Anesthésie-Réanimation Thoraco-Abdominal, CMC Magellan, CHU Bordeaux, Pessac, France.
⁶ Département d'Anesthésie-Réanimation, Sorbonne Université, GRC 29, AP-HP, DMU DREAM, Hôpital de la Pitié-Salpêtrière, Paris, France.

PMID: 39348821
DOI: 10.1159/000540553

Abstract

Introduction: Anticoagulation for continuous renal replacement therapy (CRRT) can be performed using systemic anticoagulation or regional citrate anticoagulation (RCA). The 2012 Kidney Disease Improving Global Outcomes guidelines support the use of RCA as the first-line strategy in patients requiring CRRT, with and without bleeding risk. Implementing RCA in the intensive care unit (ICU) implies involving all medical and nursing staff. The primary objective of this study was to report and describe the various anticoagulation strategies for CRRT in French ICUs. The secondary objectives were to determine the rate of RCA use and to identify the factors limiting its implementation.

Methods: An online questionnaire containing 40 questions was sent to attending physicians and fellows practicing in French ICUs between May and September 2021. The questionnaire was sent via several networks: mailing list from the French Society of Anesthesia and Intensive Care Medicine and mailing lists of RRT manufacturers.

Results: A total of 597 responses were analyzed. RCA was used by most of the participants for patients with (81%) and without (80%) increased bleeding risk. The preferred CRRT modality of the participants while using RCA was continuous veno-venous hemodialysis (48%). The clinical situations frequently reported as an absolute contraindication to RCA were uncontrolled shock associated with liver failure and drug poisoning impairing citrate metabolism (62% and 52%, respectively). In case of a higher risk of citrate accumulation, most participants claimed to perform closer biological monitoring (57%) or to modify the CRRT protocol (61%). Among the participants who did not prescribe RCA as a first-line strategy, the main factors limiting its implementation were the lack of nurse (50%) or physician (34%) training.

Conclusion: RCA is the main anticoagulation strategy prescribed for CRRT in France. Providing medical and nursing staff easy access to training may facilitate the understanding and use of RCA as the first-line anticoagulation strategy for CRRT.

Keywords: Acute kidney injury; Anticoagulation; Citrate; Renal replacement therapy; Training.