Faculty Sponsor

Jana Stedman

College

College of Nursing & Health Professions (CONHP)

Department/Program

Physician Assistant Studies

Presentation Type

Poster Presentation

Symposium Date

Summer 7-22-2026

Abstract

Objective: To evaluate whether alternative approaches to regional citrate anticoagulation implementation may be more broadly integrated into continuous renal replacement therapy (CRRT) for critically ill intensive care unit patients compared to systemic heparin or no anticoagulation by assessing mortality, filter lifespan, electrolyte and metabolic complications, and monitoring intensity.

Methods: A narrative literature review was performed including studies from PubMed, Google Scholar, and the National Center for Biotechnology Information. Studies were included if they involved adults in the intensive care unit (ICU), patients undergoing CRRT or continuous venovenous hemofiltration (CVVHF), and evaluated anticoagulation strategies such as RCA, unfractionated heparin, or no anticoagulation. Studies were excluded if they involved pediatric populations, non-ICU patients, alternative anticoagulants, patients not requiring CRRT, were published more than 20 years prior, or where n < 30. Primary endpoints included mortality, filter lifespan, and electrolyte or metabolic abnormalities. Secondary endpoints included monitoring intensity.

Results: Evidence suggests that RCA prolonged filter lifespan, reduced bleeding, and reduced circuit clotting compared with systemic heparin with comparable mortality. Alternative RCA implementation strategies were shown to preserve treatment efficacy and maintain patient safety while reducing implementation barriers. Complications associated with RCA were able to be easily corrected with standardized protocols.

Conclusion: Current evidence suggests that RCA may be safely implemented in a larger patient population and across larger variations of hospital size and capabilities.

Keywords: Regional citrate anticoagulation; continuous renal replacement therapy; continuous venovenous hemofiltration; intensive care unit; filter lifespan; anticoagulation

Biographical Information about Author(s)

Josh Sylvester is a Physician Assistant with a strong interest in critical care medicine. Following graduation, he hopes to practice in critical care or hospital medicine while continuing to expand his knowledge of complex patient management. He will be presenting on "Broadening the Integration of Regional Citrate Anticoagulation in Critically Ill ICU Patients" because of his interest in optimizing outcomes for critically ill patients through evidence based medicine

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