Citrate Versus Heparin Anticoagulation: Effect on Molecules Clearances
Status:
Unknown status
Trial end date:
2015-04-01
Target enrollment:
Participant gender:
Summary
Sepsis is responsible for 50% of all acute kidney injury (AKI) in intensive care units
(ICUs), contributing greatly to multiple organ dysfunction syndrome (MODS). Special types of
continuous renal replacement therapies (CRRT) have been proposed as adjuvant therapies for
septic shock due to their ability to remove middle molecular weight molecules such as
inflammatory mediators involved in MODS pathophysiology. These therapies are called
extracorporeal " blood purification " therapies.
When CRRT is used, an anticoagulation is required to prevent clotting of the extracorporeal
circuit, possibly causing bleeding in selected patients. Many anticoagulation strategies have
been proposed and the most commonly used in 2013 is still unfractionated heparin. Regional
citrate anticoagulation (RCA) is an interesting alternative as it dramatically decreases the
bleeding risk.
The investigators hypothesize that the use of citrate with Super High Flux Continuous
Veno-Venus Hemodialysis (SHF-CVVHD) would be highly beneficial over time by preserving the
filter effectiveness via limiting protein adhesion (which subsequently reduces filter pore
sizes (protein cake)), as compared to heparin. Consequently, higher clearances of the
inflammatory mediators could be maintained over time with citrate as compared to heparin
anticoagulation. In other words, for the same duration of filter use, middle molecular weight
molecules and cytokines clearances would be greater with citrate as compared to heparin. To
test this hypothesis, the investigators will perform a clinical randomized controlled trial
which aim would be to compare middle molecular weight molecules and cytokines clearances in
SHF-CVVHD using RCA versus systemic heparin anticoagulation in septic patients with AKI.