Regional Citrate Anticoagulation (RCA) Compared with No Heparin in Continuous Kidney Replacement Therapy (CKRT) among Liver Patients: A Single-Center, Retrospective, Interim Analysis

Background: We divided the study population into chronic liver disease (CLD), and acute liver failure (ALF) or acute on chronic liver failure (ACLF) and compared the outcomes of RCA with no heparin. Methods: This was an ethically approved, retrospective, single-center study conducted between 10 July 2022 to 26 Sept 2023.The study population (n = 309) was divided into CLD (n =173), ALF (n = 62) and ACLF (n = 74).CVVHDF modality was used where citrate dosing of 3 mmol/L maintaining a range of 2 mmol/L to 2.4 mmol/L was used. The primary outcome measured was difference in filter life span. Secondary outcomes were ammonia, lactate and pH improvement. Results: 309 patients were studied.173 CLD patients,44 received RCA and 129 received no anticoagulation.The median age of CLD was 50(40-57) years.A total of136 comprised of ALF and ACLF patients. ALF and ACLF cases were contributed by hepatitis A (43.5%) and acute alcoholic hepatitis,CLD (56.7%) respectively. In this group, 36 received RCA and 100 had no anticoagulation.The median age of this group was 38(28.75-47) years.The baseline clinical and laboratory parameters in the all the groups were statistically insignificant.The median duration of CKRT duration overall was 42 hours. In the KM analysis, RCA group had longer filter clotting time compared to no anticoagulation (log rank p-test = 0.001172). The length of stay from hospital admission to last follow-up or death was 11 days. Overall there was no difference in mortality between the groups with respect to choice of anticoagulation.There was no statistical difference in terms of pre and post CKRT serum ammonia, lactate, and blood pH in any of the sub groups. Conclusion: CKRT at low dose RCA is feasible in liver patients including ALF and ACLF.There were no additional metabolic complications or mortality risks associated with RCA. Also, there was significant improvement in filter life span which prompts its consideration in this high risk group of patients. Further, prospective studies are encouraged to confirm our preliminary findings.