Anticoagulation in continuous renal replacement therapy

Continuous renal replacement therapies (CRRTs) allow for gradual solute and fluid removal, In very sick patients with acute renal failure, they may be better tolerated than hemodialysis. The major drawback to CRRTs is the nee d for anticoagulation to maintain filter patency, The patients who are like ly to benefit from CRRTs are also at higher risk for bleeding from systemic anticoagulation. The most commonly used form of anticoagulation for CRRTs, low-dose heparin, causes bleeding in 10-50% of patients, Regional anticoag ulation using protamine may reduce the risk of bleeding, but it is difficul t to use. Low molecular weight heparin and prostacyclin both may partially reduce bleeding, but are difficult to dose. Regional anticoagulation with c itrate is easy to use and has been shown to prolong filter life without sys temic anticoagulation, It is the anticoagulant of choice for most patients on CRRT, Curr Opin Nephrol Hypertens 8:701-707. (C) 1999 Lippincott William s & Wilkins.