Regional citrate anticoagulation versus systemic heparin anticoagulation for continuous kidney replacement therapy in intensive care
Main finding · 90-day mortalityResult — go to the resultAdjusted odds ratio 0.98 95% CI 0.89–1.08Authors' conclusion
Transition to RCA was associated with significant increases in healthcare resource use, without corresponding clinical benefit, and is highly unlikely to be cost-effective over a one-year time horizon.
Study context
- Population
- Adults receiving continuous kidney replacement therapy (CKRT) in general intensive care units (ICUs) in England and Wales, 2009–2017
- Participants
- 69,001 adults · 181 ICUs
- Exposure
- ICU transition to regional citrate anticoagulation (RCA) vs systemic heparin anticoagulation (SHA) for CKRT
- RCAn = 8,585
- SHAn = 60,416reference
- Outcome
- Mortality
- Follow-up
- 90 days
Methodological detailslinked routinely collected health records, national survey of ICUs, health economic evaluation, multicentre
- Linked routinely collected health records
- National survey of ICUs
- Health economic evaluation
- Multicentre
Main finding
90-day mortality
Adjusted odds ratio
0.98
95% CI 0.89–1.08
RCA vs SHA
aOR 0.98 (95% CI 0.89–1.08)
As reported in the abstract
Observational data: associations, not effects.
Further findings
| Outcome | Step-increase (days) (95% CI) | |
|---|---|---|
| Duration of kidney supportAfter transition to RCA · interrupted time-series analysis | 0.53 (0.28–0.79) | |
| Advanced cardiovascular supportAfter transition to RCA · interrupted time-series analysis | 0.23 (0.09–0.38) | |
| ICU LOSAfter transition to RCA · interrupted time-series analysis | 0.86 (0.24–1.49) | |
| −1012Difference, days (linear scale) |
Incremental net monetary benefit per patient · one year
- Estimated incremental net monetary benefit per patient
- £ - 2376 (95% CI £ - 3841-£ - 911)
- Estimated likelihood of cost-effectiveness
- <0.1%
Original publication
Regional citrate anticoagulation versus systemic heparin anticoagulation for continuous kidney replacement therapy in intensive care. J Crit Care. Published 7 December 2022. doi:10.
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