Different anticoagulation methods for continuous renal replacement therapy in patients with hyperlactataemia and a high risk of bleeding

Background: There is a lack of consensus regarding the optimal anticoagulation strategy for continuous renal replacement therapy (CRRT) in patients with hyperlactataemia and a high risk of bleeding. The purpose of this study was to evaluate the safety and efficacy of the commonly used anticoagulation methods for CRRT in these patients. Methods: The present study included patients with hyperlactataemia (⩾2 mmol/L) and a high risk of bleeding who underwent CRRT at Xijing Hospital from 2020 to 2024. Filter lifespan, bleeding complications, blood infusion and adverse effects were recorded. Results: The present study included a total of 53 patients who underwent no anticoagulation (NA)-CRRT, 32 patients who underwent nafamostat mesylate (NM)-CRRT and 47 patients who underwent regional citrate anticoagulation (RCA)-CRRT. The filter lifespan was significantly different among the three groups (NA = 25 h (IQR = 18.4, 34.5), NM = 41 h (IQR = 24.0, 54.3) and RCA = 36 h (IQR = 23.0, 53.5), p < 0.001). The 30-day mortality rate was significantly higher in the NA group ( p = 0.037). Furthermore, the incidence of bleeding complications (43.4%, p = 0.003) and blood transfusions (28.3%, p = 0.047) were higher in the NA group. Conclusion The utilization of either NM or RCA has the potential to extend the filter lifespan and may be associated with a reduced risk of bleeding. These findings suggest that NM and RCA may be safe and effective for CRRT patients with hyperlactataemia and a high risk of bleeding if careful monitoring and timely adjustment are employed.