Anticoagulación en circuitos de terapias continuas de reemplazo renal

Abstract

Continuous renal replacement therapies are used as a means of blood clearance in critically ill patients with acute renal failure. Its effectiveness depends on the permeability of the extracorporeal circuit and filter coagulation is the most frequent cause of treatment interruption. This situation carries a risk of blood loss for the patient.

Sodium heparin is the most widely used anticoagulant in these therapies, but it can increase the risk of bleeding. Regional citrate anticoagulation is a safer method compared to sodium heparin.

Citrate is a substance that works by inactivating ionic calcium that participates in the coagulation cascade. It's infused at the inlet of the circuit and neutralized before reaching the patient with calcium replacement. For this reason, it is considered a regional and non-systemic anticoagulant.

However, this anticoagulation system, despite being indicated as the first option by the KDIGO guidelines (Kidney Disease Improving Outcomes), is not yet widespread due to the complexity of its use. It requires specific training for healthcare personnel, especially nurses, who will be responsible for maintaining the circuit while the therapy lasts.

In this article we want to provide the necessary knowledge about anticoagulation to carry out these procedures safely and effectively.