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What is the RRAM study?

It is common for patients in intensive care units (ICUs) to have a kidney injury which prevents their kidney from working properly. If this happens the patients are treated with a machine that takes over the kidney functions and allows their own kidneys to recover. This process is called continuous renal replacement therapy (CRRT). Traditionally as part of this procedure, a medicine called heparin is added to the blood as it enters the CRRT machine to prevent the blood from clotting and clogging the machine. This process is termed anticoagulation. Recently citrate anticoagulation (an alternative to heparin) is being increasingly used in UK ICUs because it may be controllable and cheaper than the traditional heparin. However, both heparin and citrate anticoagulation are associated with different risks to the patient. Currently we do not know if one form of anticoagulation is better than the other as there have not been any direct comparisons of the effects of using heparin and citrate for CRRT. The Renal Replacement Anticoagulant Management (RRAM) study will research the advantages and disadvantages of the two anticoagulant methods for patients with a kidney injury and treated in an ICU.

What does the study involve?

ICNARC holds the data for the Case Mix Programme (CMP) which is the national clinical audit for adult, general critical care units in England, Wales and Northern Ireland. The CMP includes intensive care and combined intensive care and

high dependency units in the NHS and collects high quality data on patient outcomes for all adults that are admitted to a critical unit in the UK (more information about the CMP can be found here; link to: https://www.icnarc.org/Our-Audit/Audits/Cmp/About). As part of the RRAM study we will use this existing high quality data collected for the CMP to help answer the research question. To get a more comprehensive view of the long-term effects of using the different anticoagulation methods to treat people with a kidney injury in the ICU, we will ‘link’ data from the CMP together with the following national datasets that contain information about patient outcomes after leaving hospital:

• Hospital Episode Statistics (HES) inpatient data which contains details of hospital admissions at NHS hospitals in England – held by NHS Digital

• Patient Episodes Data for Wales (PEDW) which collects inpatient data for Wales – held by NHS Wales Informatics Service (NWIS)

• Office for National Statistics (ONS) mortality data which will tell us about patients’ long-term survival – held by NHS Digital

• UK Renal Registry (UKRR) which will tell us if patients go on to have long term kidney problems after leaving the ICU

This study is funded by the National Institute for Health Research (NIHR) – Health Technology Assessment (HTA) Programme (Project: 16/111/136

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