Evidence map›Paper›PMID 25128022›Full record

Trial reportCritical care (London, England)2014

Citrate anticoagulation versus systemic heparinisation in continuous venovenous hemofiltration in critically ill patients with acute kidney injury: a multi-center randomized clinical trial.

Louise Schilder, S Azam Nurmohamed, Frank H Bosch, Ilse M Purmer, Sylvia S den Boer, Cynthia G Kleppe, Marc G Vervloet, Albertus Beishuizen, Armand R J Girbes, Pieter M Ter Wee and 2 more

2 registry-linked trialsOpen access · goldAbstract readMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Critical care (London, England), 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 78 papers, 10 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
78citing papers in PubMed, 10 pooled it
9.7field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT00209378 nacompletednot on this map

Citrate Versus Heparin Anticoagulation in Continuous Venovenous Hemofiltration in Critically Ill Patients With Acute Renal Failure: A Randomized Clinical Trial

TypeinterventionalSponsorUniversitair Ziekenhuis BrusselRan2005 to 2012Enrolled139ConditionsAcute Kidney InjuryArmsregional anticoagulation with citrate, HfCitPre
NCT05148026 nacompletednot on this mapstarted 2021, after this paper: background citation

Regional Citrate Anticoagulation for Continuous Renal Replacement Therapy During Veno-venous ECMO: a Crossover Randomized Controlled Study

TypeinterventionalSponsorUniversity of Milano BicoccaRan2021 to 2025Enrolled18ConditionsARDS, Human, Acute Kidney InjuryArmsUnfractionated heparin + RCA first, Unfractionated heparin first
3 · Its place in the literature

Who cites it

78 citing papers in PubMed, 10 syntheses or guidelines pooled it, 181 citations in OpenAlex.

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  18. Treatment Effect of Regional Sodium Citrate Anticoagulation in Elderly Patients With High-Risk Bleeding Receiving Continuous Renal Replacement Therapy.Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis
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18 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

12 authors at 6 institutions in 1 country.

Louise Schilder
S Azam Nurmohamed
Frank H Bosch
Ilse M Purmer
Sylvia S den Boer
Cynthia G Kleppe
Marc G Vervloet
Albertus Beishuizen
Armand R J Girbes
Pieter M Ter Wee
A B Johan Groeneveld
CASH study group
Amsterdam UMC Location VUmc · NLErasmus MC · NLHaga Hospital · NLMedisch Centrum Alkmaar · NLRijnstate Hospital · NLSpaarne Ziekenhuis · NL

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionBecause of ongoing controversy, renal and vital outcomes are compared between systemically administered unfractionated heparin and regional anticoagulation with citrate-buffered replacement solution in predilution mode, during continuous venovenous hemofiltration (CVVH) in critically ill patients with acute kidney injury (AKI).

methodsIn this multi-center randomized controlled trial, patients admitted to the intensive care unit requiring CVVH and meeting inclusion criteria, were randomly assigned to citrate or heparin. Primary endpoints were mortality and renal outcome in intention-to-treat analysis. Secondary endpoints were safety and efficacy. Safety was defined as absence of any adverse event necessitating discontinuation of the assigned anticoagulant. For efficacy, among other parameters, survival times of the first hemofilter were studied.

resultsOf the 139 patients enrolled, 66 were randomized to citrate and 73 to heparin. Mortality rates at 28 and 90 days did not differ between groups: 22/66 (33%) of citrate-treated patients died versus 25/72 (35%) of heparin-treated patients at 28 days, and 27/65 (42%) of citrate-treated patients died versus 29/69 (42%) of heparin-treated patients at 90 days (P = 1.00 for both). Renal outcome, i.e. independency of renal replacement therapy 28 days after initiation of CVVH in surviving patients, did not differ between groups: 29/43 (67%) in the citrate-treated patients versus 33/47 (70%) in heparin-treated patients (P = 0.82). Heparin was discontinued in 24/73 (33%) of patients whereas citrate was discontinued in 5/66 (8%) of patients (P < 0.001). Filter survival times were superior for citrate (median 46 versus 32 hours, P = 0.02), as were the number of filters used (P = 0.002) and the off time within 72 hours (P = 0.002). The costs during the first 72 hours of prescribed CVVH were lower in citrate-based CVVH.

conclusionsRenal outcome and patient mortality were similar for citrate and heparin anticoagulation during CVVH in the critically ill patient with AKI. However, citrate was superior in terms of safety, efficacy and costs.

trial registrationClinicaltrials.gov NCT00209378. Registered 13th September 2005.

Indexed as

Acute Kidney InjuryAdultAgedAged, 80 and overAnticoagulantsCitric AcidCritical IllnessFemaleHemofiltrationHeparinHumansIntensive Care UnitsMaleMiddle AgedNetherlandsOrgan Dysfunction ScoresAnticoagulantsCitric AcidHeparin

Identifiers

PMID25128022
PMCPMC4161888
OpenAlexW2019511213

What OpenQuestion holds

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LicenceCC BY
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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.