Anticoagulation for Continuous Renal Replacement Therapy

Continuous renal replacement therapy (CRRT) is the preferred modality of dialysis in hemodynamically unstable critically ill patients with kidney failure. Interruptions from circuit clotting arising from activation of intrinsic and extrinsic pathways of coagulation and activation of platelets can result in decreased effectiveness of CRRT therapy. Although CRRT can be performed without anticoagulation, most patients require some form of anticoagulation to decrease extracorporeal circuit clotting. This chapter discusses the most common anticoagulation options for CRRT: unfractionated heparin and regional citrate anticoagulation. Other less common options, including protamine reversal, low-molecular-weight heparin (LMWH), thrombin antagonists (argatroban and bivalirudin), and platelet-inhibiting agents, are briefly discussed.