A study of citrate and bivalirudin for anticoagulation during continuous renal replacement therapy in critically ill patients with acute kidney injury

Background: During continuous renal replacement therapy (CRRT), regional citrate anticoagulation (RCA) and bivalirudin are appealing alternatives since they provide excellent anticoagulation within the circuit without increasing the risk of bleeding. This study has been done to assess the hemofilter survival time, length of intensive care unit (ICU) stays, bleeding, thrombosis, and kidney function in bivalirudin and RCA. Methods: A total of 40 patients who needed CRRT were enrolled in the study with acute kidney injury (AKI). The patients were divided into two groups of 20 each. RCA was used in the CRRT in the first group and bivalirudin in the second group according to protocol. We have monitored serum urea, serum creatinine, last 24 h urine output, hemoglobin (Hb), platelet count, prothrombin time (PT), international normalized ratio (INR), serum albumin, any bleeding complication, or any transfusion requirement pre-CRRT, during CRRT, and after CRRT. Results: Hemofilter life span was found significantly longer in the citrate group than the bivalirudin group (67.75 ± 16.64 vs 50.65 ± 7.98, P < 0.001). Length of ICU stay is found to be non-significant between the groups ( P > 0.05). Significant difference was found in S. Creatinine level and urine output from pre-CRRT to post-CRRT in both the groups ( P < 0.05), but no significant difference was found in pre-CRRT, during CRRT, and post-CRRT between both the groups ( P > 0.05). No significant difference was found in terms of mortality, bleeding, and transfusion between the groups ( P > 0.05). Conclusion: After observing the data and statistical evaluation, we found that RCA has a better hemofilter life span than bivalirudin without a significant difference in mortality, bleeding, or transfusion.