DOI: 10.1177/03000605261464273 ISSN: 0300-0605

Regional citrate versus systemic heparin anticoagulation in continuous renal replacement therapy for sepsis-associated acute kidney injury: A retrospective cohort study of short-term outcomes

Jian Lan, Yifeng Mao, Chenyang Shi, Qingqing Chen, Shangwen Cai, Xijiang Zhang, Cheng Zheng
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Objective

To compare the clinical outcomes and prognosis of regional citrate anticoagulation and systemic heparin anticoagulation in patients with sepsis-associated acute kidney injury undergoing continuous renal replacement therapy.

Methods

This retrospective cohort study (2020–2024) included 168 adults with sepsis-associated acute kidney injury who received continuous renal replacement therapy at the intensive care unit of Taizhou Municipal Hospital. Kaplan–Meier curves and multivariable Cox regression were used to evaluate 14- and 28-day mortality, with subgroup analyses performed to assess effect modification.

Results

Among 168 eligible patients, 1:1 propensity score matching yielded 42 well-balanced pairs (regional citrate anticoagulation, n = 42; systemic heparin anticoagulation, n = 42) with comparable baseline characteristics. Hospital mortality was lower with regional citrate anticoagulation (59.5%) than with systemic heparin anticoagulation (71.4%); however, the difference did not reach statistical significance ( P  = 0.251). The 14-day comparison demonstrated a higher survival probability with regional citrate anticoagulation (log-rank P  = 0.043; hazard ratio, 2.10; 95% confidence interval: 1.01–4.39), and a similar benefit persisted at 28 days (log-rank P  = 0.042; hazard ratio, 1.76; 95% confidence interval: 1.01–3.05). Subgroup analysis further indicated that the survival benefit of regional citrate anticoagulation on 28-day mortality was most pronounced among patients with pre-existing hypertension (hazard ratio, 2.75; 95% confidence interval: 1.32–5.71; P  = 0.007; interaction P  = 0.028).

Conclusions

In patients with sepsis-associated acute kidney injury requiring continuous renal replacement therapy, regional citrate anticoagulation may confer better short-term (14- and 28-day) survival than systemic heparin anticoagulation; however, no clear difference in overall hospital mortality was observed. This potential benefit may be more pronounced among patients with hypertension, meriting further evaluation of tailored anticoagulation approaches.

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