Objective To summarize and analyze the application of regional citrate anticoagulation (RCA) in patients undergoing continuous renal replacement therapy (CRRT) using a scoping review methodology.
Methods Following the scoping review methodology, a systematic search was conducted in domestic and international databases, including CNKI, Wanfang Data, Cochrane Library, PubMed, and Embase for literature related to RCA in CRRT patients. The search was limited from the inception of the databases to August 10, 2023. Included studies were screened, summarized, and analyzed.
Results A total of 19 articles were included in this study, comprising 8 randomized controlled trials, 8 cohort studies, 2 case-control studies, and 1 cross-sectional survey. Anticoagulation methods for CRRT primarily included unfractionated heparin, low-molecular-weight heparin, thrombin inhibitors, nafamostat, and RCA. Compared to other anticoagulation methods, RCA exhibited advantages in lower bleeding risk and longer filter lifespan. Calcium ion monitoring during RCA application predominantly relies on the empirical trial-and-error approach. Major complications associated with RCA include citrate accumulation, acid-base imbalance, and ion metabolic disorders. For patients with high bleeding risk, hypercalcemia, and sepsis, RCA may confer greater benefits during CRRT.
Conclusion RCA has gradually emerged as a preferred anticoagulation method for CRRT patients, offering advantages in extending filter lifespan and reducing bleeding risk. Future research should focus on calcium ion monitoring during RCA, enhancing safety and efficacy through targeted infusion systems, and further exploring the immunomodulatory effects of RCA and its mechanisms related to high inflammatory factor clearance rates.
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