Regional Citrate vs. Systemic Heparin Anticoagulation During Continuous Kidney Replacement Therapy Among Critically Ill Patients with AKI: A Randomized Clinical Trial
Bibliographic record
Abstract
Background: Although current guidelines suggest the use of regional citrate anticoagulation as first-line treatment for continuous kidney replacement therapy in critically ill patients, the evidence for this recommendation is based on few clinical trials and meta-analyses. Methods: To determine the effect of anticoagulation strategies on filter lifespan and mortality, a parallel-group, randomized multicenter clinical trial was conducted in 26 centers across Germany between March 2016 and December 2018. Patients were randomized to receive either regional citrate (n=300) or systemic heparin anticoagulation (n=296) for continuous kidney replacement therapy. The two co-primary outcomes were filter lifespan and 90-day all-cause mortality. Secondary endpoints included bleeding complications and new infections. Results: Among 638 patients randomized, 596 (93.4%) patients (mean age, 67.5 (±12.4) years, 183 (30.7%) women) completed the trial. Median filter lifespan was 47h [IQR, 19-70h] in the regional citrate and 26h [IQR, 2-51h] in the systemic heparin group; absolute difference (AD), 15h [95%CI, 11h to 20h]; P<0.001). 90-day all-cause mortality was 51.2% (150/300) in the regional citrate and 53.6% (156/296) in the systemic heparin anticoagulation group (adjusted AD, -6.1% [95%CI, -12.6% to 0.4%]; adjusted HR, 0.79 [95%CI, 0.63 to 1.004]; adjusted P=0.054; unadjusted AD, -2.4% [95%CI, -10.5% to 5.8%]; unadjusted HR, 0.91 [95%CI, 0.72 to 1.13]; unadjusted P=0.38). Compared with systemic heparin anticoagulation, the regional citrate anticoagulation group had significantly fewer bleeding complications (15/300 [5.1%] vs. 49/296 [16.9%]; AD, -11.8% [95% CI, -16.8% to 6.8%]; P<0.001) and significantly more new infections (204/300 [68.0%] vs. 164/296 [55.4%]; AD, 12.6% [95% CI, 4.9% to 20.3%]; P=0.002). Conclusions: Among critically ill patients with acute kidney injury receiving continuous kidney replacement therapy, anticoagulation with regional citrate, compared with systemic heparin anticoagulation, resulted in significantly longer filter lifespan. The trial was terminated early and was therefore underpowered to reach conclusions about the effect of anticoagulation strategy on mortality. Funding: Government Support - Non-U.S.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.007 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.005 | 0.005 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".