Please select the arm or intervention descriptions that belong to the clinical trial below.
Title: Citrate-based Regional Anticoagulation Versus Heparin for Continuous Renal Replacement Therapy in Critically Ill Patients With Acute Renal Failure: a Randomized Controlled Trial
Brief Summary: Critically ill patients with acute kidney injury (AKI) are at high risk of bleeding on account of coagulopathy, platelet dysfunction, frequent liver dysfunction and invasive procedures.In patients at high risk of bleeding, anticoagulation restricted to the circuit (regional anticoagulation) has been advocated as the method of choice.However, citrate anticoagulation may have many metabolic consequences, such as metabolic alkalosis due to citrate metabolism into bicarbonate, and in patients with liver disease, metabolic acidosis and hypocalcemia may occur.Implementation of citrate-based regional anticoagulation with frequent monitoring of acid-base and electolytes is also more challenging for the nurses and does not eliminate the need of a low-dose systemic anticoagulation for thromboses prophylaxis in most of the patients. Citrate-based regional anticoagulation is therefore mainly advocated only for patients at high-risk of bleeding.

The investigators plan to implement an open-label randomized control trial assessing the effectiveness of citrate-based regional anticoagulation in critically ill patients with AKI and with a special emphasis on the safety profile of this treatment in patients with severe liver failure.


Options:
A: Arm Label: AKI requring CRRT and use regional citrate anticoagulation; Type: EXPERIMENTAL; Interventions: Procedure: Continuous renal replacement therapy with regional citrate anticoagulation | Arm Label: AKI requring CRRT and not use regional citrate anticoagulation; Type: EXPERIMENTAL; Interventions: Procedure: Continuous renal replacement therapy with no anticoagulation or heparin | Intervention Type: PROCEDURE; Name: Continuous renal replacement therapy with regional citrate anticoagulation; Assigned to Arm(s): AKI requring CRRT and use regional citrate anticoagulation | Intervention Type: PROCEDURE; Name: Continuous renal replacement therapy with no anticoagulation or heparin; Assigned to Arm(s): AKI requring CRRT and not use regional citrate anticoagulation
B: Arm Label: heparin; Type: PLACEBO_COMPARATOR; Interventions: Device: citrate regional anticoagulation | Arm Label: citrate regional anticoagulation; Type: ACTIVE_COMPARATOR; Interventions: Device: citrate regional anticoagulation | Intervention Type: DEVICE; Name: citrate regional anticoagulation; Assigned to Arm(s): heparin | Intervention Type: DEVICE; Name: citrate regional anticoagulation; Assigned to Arm(s): citrate regional anticoagulation, heparin
C: Arm Label: citrate; Type: ACTIVE_COMPARATOR; Interventions: Drug: trisodium citrate | Arm Label: nadroparin; Type: ACTIVE_COMPARATOR; Interventions: Drug: nadroparin | Intervention Type: DRUG; Name: trisodium citrate; Assigned to Arm(s): citrate | Intervention Type: DRUG; Name: nadroparin; Assigned to Arm(s): nadroparin
D: Arm Label: Nafamostat mesilate group; Type: ACTIVE_COMPARATOR; Interventions: Drug: Nafamostat mesilate | Arm Label: No anticoagulation group; Type: PLACEBO_COMPARATOR; Interventions: Drug: Normal saline | Intervention Type: DRUG; Name: Nafamostat mesilate; Assigned to Arm(s): Nafamostat mesilate group | Intervention Type: DRUG; Name: Normal saline; Assigned to Arm(s): No anticoagulation group

Answer: B