Regional Citrate Anticoagulation and Infectious Complications in Critically Ill Children and Young Adults Receiving Continuous Renal Replacement Therapy
Year: 2025
Type: article
Abstract: INTRODUCTION: Recent studies have identified an association between regional citrate anticoagulation (RCA) and subsequent infectious complications during continuous renal replacement therapy (CRRT). We aimed to determine if RCA was associated with infectious complications in children and young adults receiving CRRT. METHODS: A secondary analysis of the multinational Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease (WE-ROCK) registry (34 centers, 9 countries), was performed, including patients from 2015 to 2018. Patients were excluded if they (1) died within 72 h of CRRT initiation, had minor trauma or were postsurgical (analysis 1), or (2) met an exclusion in analysis 1 or had sepsis prior to CRRT initiation or chronic immunosuppression (analysis 2). Multivariable mixed-effects logistic (analysis 1) and mixed-effects Cox regression (analysis 2) were used to determine the associations between anticoagulant type and culture-positive infection after CRRT initiation. RESULTS: A total of 874 patients were included in analysis 1 and 283 in analysis 2. Culture-positive infection occurred in 25% and 17% of each analysis. In analysis 1, culture-positive infection was higher in RCA (29%) vs. heparin (23%) and other (15%); p = 0.008. There was no association between RCA and infection in multivariable analysis. In analysis 2, there was no difference in the frequency of infection by anticoagulation type. A longer time to achieve the first negative fluid balance was associated with culture-positive infection. CONCLUSION: RCA was not associated with culture-positive infection after CRRT initiation in this study. The systemic effects of AKI and longer time to first negative fluid balance may be inciting factors for an infection and represent a potentially modifiable factor that warrants future studies in this high-risk population.
DOI: 10.1159/000548253
Authors: Katja M. Gist, Sai Prasad N. Iyer, H. David Humes, Stuart L. Goldstein, Mihaela Damian, Andrea Cappoli, Catherine Joseph, Danielle E. Soranno, Michelle Starr, Ashita Tolwani, Kevin K. Chung, Theresa Mottes, Huaiyu Zang, JangDong Seo, Nicholas J. Ollberding, Shina Menon, the WE-ROCK Investigators
Institutions: Children's Hospital Colorado, University of Colorado Anschutz, University of Michigan, Michigan Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Emory University, Children's Healthcare of Atlanta, Bambino Gesù Children's Hospital, Istituti di Ricovero e Cura a Carattere Scientifico, Baylor College of Medicine, Texas Children's Hospital, Riley Hospital for Children, Indiana University School of Medicine, University of Alabama at Birmingham, UAB Medicine, Lurie Children's Hospital, Lucile Packard Children's Hospital, Stanford Medicine, Stanford University
Language: English
Topic: Acute Kidney Injury Research
Subfield: Nephrology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W4414201536