• Tomáš Zaoral, Michal Hladík, Jana Zapletalová, Bořek Trávníček, and Eliška Gelnarová.
• 1Pediatric Intensive Care Unit, Department of Pediatrics, Faculty of Medicine, University Hospital Ostrava, Ostrava, Czech Republic. 2The Department of Medical Biophysics, Faculty of Medicine, University hospital Olomouc, Olomouc, Czech Republic.
• Pediatr Crit Care Me. 2016 Sep 1; 17 (9): e399-405.

ObjectivesTo determine if there is a difference between regional citrate and global heparinized anticoagulation on circuit lifetimes during continuous venovenous hemodialysis in children.DesignProspective "cross-over" trial.SettingPICU, Department of Pediatrics, University Hospital Ostrava.PatientsChildren 0-18 years old.InterventionsFrom 2009 to 2014, 63 eligible children (age, 89.24 ± 62.9 mo; weight, 30.37 ± 20.62 kg) received at least 24 hours of continuous venovenous hemodialysis. Each child received four continuous venovenous hemodialysis circuits with anticoagulants in the following order: heparin, citrate, heparin, citrate. Circuit life ended when transmembrane pressure was greater than or equal to 250 mm Hg for more than 60 minutes.Measurements And Main ResultsThe total mean circuit lifetime was 39.75 ± 10.73 hours. Citrate had a significantly longer median circuit lifetime (41.0 hr; CI, 37.6-44.4) than heparin (36.0 hr; CI, 35.4-36.6; p = 0.0001). Mortality was 33.33%. Circuit lifetime was significantly correlated to patient age (r = 0.606), weight (r = 0.763), and blood flow rate (r = 0.697). Transfusion rates (units of red cells per circuit of continuous venovenous hemodialysis) were 0.17 (0.0-1.0) with citrate and 0.36 (0.0-2.0) with heparin (p = 0.002).ConclusionsWe showed in our study that citrate provided significantly longer circuit lifetimes than heparin for continuous venovenous hemodialysis in children. Citrate was superior to heparin for the transfusion requirements. Citrate was feasible and safe in children and infants.

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