A scoping review in the application of regional citrate anticoagulation in patients undergoing continuous renal replacement therapy
Objective To summarize and analyze the application of regional citrate anticoagula-tion(RCA)in patients undergoing continuous renal replacement therapy(CRRT)using a scoping re-view methodology.Methods Following the scoping review methodology,a systematic search was con-ducted in domestic and international databases,including CNKI,Wanfang Data,Cochrane Library,PubMed,and Embase for literature related to RCA in CRRT patients.The search was limited from the inception of the databases to August 10,2023.Included studies were screened,summarized,and ana-lyzed.Results A total of 19 articles were included in this study,comprising 8 randomized controlled trials,8 cohort studies,2 case-control studies,and 1 cross-sectional survey.Anticoagulation methods for CRRT primarily included unfractionated heparin,low-molecular-weight heparin,thrombin inhibi-tors,nafamostat,and RCA.Compared to other anticoagulation methods,RCA exhibited advantages in lower bleeding risk and longer filter lifespan.Calcium ion monitoring during RCA application predomi-nantly relies on the empirical trial-and-error approach.Major complications associated with RCA in-clude citrate accumulation,acid-base imbalance,and ion metabolic disorders.For patients with high bleeding risk,hypercalcemia,and sepsis,RCA may confer greater benefits during CRRT.Conclusion RCA has gradually emerged as a preferred anticoagulation method for CRRT patients,offering ad-vantages in extending filter lifespan and reducing bleeding risk.Future research should focus on calcium ion monitoring during RCA,enhancing safety and efficacy through targeted infusion systems,and further exploring the immunomodulatory effects of RCA and its mechanisms related to high inflammatory factor clearance rates.
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