Different anticoagulation methods for continuous renal replacement therapy in patients with hyperlactataemia and a high risk of bleeding.

BACKGROUND

There is a lack of consensus regarding the optimal anticoagulation strategy for continuous renal replacement therapy (CRRT) in patients with hyperlactataemia and a high risk of bleeding. The purpose of this study was to evaluate the safety and efficacy of the commonly used anticoagulation methods for CRRT in these patients.

METHODS

The present study included patients with hyperlactataemia (⩾2 mmol/L) and a high risk of bleeding who underwent CRRT at Xijing Hospital from 2020 to 2024. Filter lifespan, bleeding complications, blood infusion and adverse effects were recorded.

RESULTS

The present study included a total of 53 patients who underwent no anticoagulation (NA)-CRRT, 32 patients who underwent nafamostat mesylate (NM)-CRRT and 47 patients who underwent regional citrate anticoagulation (RCA)-CRRT. The filter lifespan was significantly different among the three groups (NA = 25 h (IQR = 18.4, 34.5), NM = 41 h (IQR = 24.0, 54.3) and RCA = 36 h (IQR = 23.0, 53.5), p < 0.001). The 30-day mortality rate was significantly higher in the NA group (p = 0.037). Furthermore, the incidence of bleeding complications (43.4%, p = 0.003) and blood transfusions (28.3%, p = 0.047) were higher in the NA group.ConclusionThe utilization of either NM or RCA has the potential to extend the filter lifespan and may be associated with a reduced risk of bleeding. These findings suggest that NM and RCA may be safe and effective for CRRT patients with hyperlactataemia and a high risk of bleeding if careful monitoring and timely adjustment are employed.