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The primary outcome measure was hemofilter survival time. Secondary outcomes included the comparison of complications and metabolic disorders.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>A total of 131 patients (55 RCA and 76 systemic heparin) were included, in which a cumulative number of 280 hemofilters were used (115 in RCA with 5762\u2009h total CRRT time, and 165 in systemic heparin with 6230\u2009h total CRRT time). Hemofilter survival was significantly longer for RCA (51.0\u2009h; IQR: 24\u201367\u2009h) compared to systemic heparin (29.5\u2009h; IQR, 17\u201348\u2009h) (<jats:italic>p<\/jats:italic>\u2009=\u20090.002). Clotting-related hemofilter failure occurred in 9.6% of the RCA group compared to 19.6% in the systemic heparin group (<jats:italic>p<\/jats:italic>\u2009=\u20090.038). Citrate accumulation occurred in 4 (3.5%) of 115 RCA sessions. Hypocalcemia and metabolic alkalosis episodes were significantly more frequent in RCA recipients (35.7% vs 15.2%, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0001; 33.0% vs 19.4%, <jats:italic>p<\/jats:italic>\u2009=\u20090.009).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>RCA is a safe and effective anticoagulation method for CRRT in critically-ill children and it prolongs hemofilter survival.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Impact<\/jats:title>\n                <jats:p><jats:list list-type=\"bullet\">\n                  <jats:list-item>\n                    <jats:p>RCA is superior to systemic heparin for the prolongation of circuit survival (overall and for clotting-related loss) during CRRT.<\/jats:p>\n                  <\/jats:list-item>\n                  <jats:list-item>\n                    <jats:p>These data indicate that RCA can be used to maximize the effective delivery of CRRT in critically-ill patients admitted to the PICU.<\/jats:p>\n                  <\/jats:list-item>\n                  <jats:list-item>\n                    <jats:p>There are potential cost-saving implications from our results owing to benefits such as less circuit downtime and fewer circuit changes.<\/jats:p>\n                  <\/jats:list-item>\n                <\/jats:list><\/jats:p>\n              <\/jats:sec>","DOI":"10.1038\/s41390-024-03163-x","type":"journal-article","created":{"date-parts":[[2024,3,30]],"date-time":"2024-03-30T19:01:31Z","timestamp":1711825291000},"page":"702-712","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Citrate anticoagulation and systemic heparin anticoagulation during continuous renal replacement therapy among critically-ill children"],"prefix":"10.1038","volume":"96","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8597-8889","authenticated-orcid":false,"given":"Seyma Koksal","family":"Atis","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhterem","family":"Duyu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zeynep","family":"Karakaya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alev","family":"Yilmaz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,3,30]]},"reference":[{"key":"3163_CR1","doi-asserted-by":"publisher","first-page":"329","DOI":"10.1053\/j.ajkd.2013.08.018","volume":"63","author":"SK Sethi","year":"2014","unstructured":"Sethi, S. 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