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The Scientific World Journal
Volume 2014, Article ID 808320, 7 pages
http://dx.doi.org/10.1155/2014/808320
Clinical Study

Anticoagulation Strategies in Venovenous Hemodialysis in Critically Ill Patients: A Five-Year Evaluation in a Surgical Intensive Care Unit

1Department of Anaesthesiology and Critical Care Medicine, Jena University Hospital, Erlanger Allee 101, 07747 Jena, Germany
2Center for Sepsis Control and Care (CSCC), Integrated Research and Treatment Center, Jena University Hospital, 07747 Jena, Germany

Received 14 July 2014; Revised 10 November 2014; Accepted 15 November 2014; Published 9 December 2014

Academic Editor: Monica Rocco

Copyright © 2014 Christoph Sponholz et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Renal failure is a common complication among critically ill patients. Timing, dosage, and mode of renal replacement (RRT) are under debate, but also anticoagulation strategies and vascular access interfere with dialysis success. We present a retrospective, five-year evaluation of patients requiring RRT on a multidisciplinary 50-bed surgical intensive care unit of a university hospital with special regard to anticoagulation strategies and vascular access. Anticoagulation was preferably performed with unfractionated heparin or regional citrate application (RAC). Bleeding and suspected HIT-II were most common causes for RAC. In CVVHD mode filter life span was significantly longer under RAC compared to heparin or other anticoagulation strategies (). Femoral vascular access was associated with reduced filter life span (), especially under heparin anticoagulation (). Patients on RAC had higher rates of metabolic alkalosis (), required more transfusions (), and showed higher illness severity measured by SOFA scores (). RRT with unfractionated heparin represented the most common anticoagulation strategy in this study population. However, patients with bleeding risk and severe organ dysfunction were more likely placed on RAC. Citrate provided longer filter life spans regardless of vascular access site. Attention has to be paid to metabolic disturbances.