Efficacy and safety of low-molecular-weight-heparin plus citrate in nephrotic syndrome during continuous kidney replacement therapy: retrospective study.

Background: Nephrotic syndrome (NS) is a condition often necessitating continuous kidney replacement therapy (CKRT) due to severe edema and other complications. Anticoagulation is critical in CKRT to prevent filter clotting, with regional citrate anticoagulation (RCA) being the first-line method. However, the hypercoagulable state of NS may require alternative strategies. Optimal anticoagulation therapy in NS patients undergoing CKRT is lacking. Methods: This retrospective observational study included 251 CKRT sessions from 122 NS patients treated at Nanfang Hospital, Southern Medical University, from January 2019 to December 2022. Patients were divided into three groups based on anticoagulation method: Low-molecular-weight-heparin (LMWH) alone, RCA alone, and RCA plus LMWH. Filter lifespan, incidence of filter clotting, and adverse events were assessed to evaluate the efficacy and safety profiles of each anticoagulation methods. Results: The combination of RCA and LMWH demonstrated a significantly longer mean filter lifespan and lower incidence of filter clotting compared to LMWH or RCA alone. RCA plus LMWH also showed a lower incidence of overall adverse events, particularly thrombosis, without an increase in bleeding complications. Multivariate Cox analysis indicated that RCA plus LMWH was particularly effective in patients with normal kidney function. Conclusions: RCA combined with LMWH provides a superior anticoagulation strategy in NS patients undergoing CKRT, with enhanced filter lifespan and reduced clotting and thrombotic events without increasing bleeding risk. Further research is needed to optimize dosing and validate these results in broader populations.