#3221 The challenge of using continuous renal replacement therapy anticoagulated with citrate in cirrhotic patients

Abstract Background and Aims The purpose of this study is to determine the feasibility of using regional anticoagulation with citrate (RAC) in Continuous Renal Replacement Therapy (CRRT) in cirrhotic patients. Method Observational descriptive study, including 10 cirrhotic patients admitted to the hepatic ICU at Hospital Clínic de Barcelona between 03/2023 and 03/2024 who required CRRT. Patient characteristics were compared between those without and with citrate anticoagulation using Mann-Whitney U tests for quantitative variables and Chi-square tests for qualitative variables. Results Of the 10 patients, 4 used the technique without citrate and 6 with RAC. The patients receiving RAC had a median age of 57 years (47–63.25), 66.6% were male. Only one patient started the technique with citrate as the first option, and the reason for switching to citrate in 4 patients was early clotting, and in 2 patients after TOH (therapeutic hemodialysis), with median flow rates of Qb 120 mL/min, Qd 1200 mL/h, and Qr 500 mL/h. 50% switched to RAC within the first 48 hours, two of them due to elevated tCa/iCa ratio, and one as a precaution in an unstable patient. There were no differences between the two groups in age, ACLF (acute-on-chronic liver failure), or liver parameters; however, comorbidity was more prevalent in the non-citrate group (P = 0.083). Overall mortality was 80% (P = 0.747). Conclusion The use of regional anticoagulation with citrate in cirrhotic patients is feasible and safe if the technique is closely monitored, with potential benefits regarding filter lifespan and the consequent increase in the effective dose of therapy.