Non-pharmacological interventions for preventing clotting of extracorporeal circuits during continuous renal replacement therapy

Tsujimoto, Yasushi; Miki, Sho; Shimada, Hiroki; Tsujimoto, Hiraku; Yasuda, Hideto; Kataoka, Yuki; Fujii, Tomoko

doi:10.1002/14651858.cd013330.pub2

Cited by 11 publications

(8 citation statements)

References 146 publications

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“…Therefore, these factors were not included in the analysis. However, these factors reportedly affect CRRT duration [4, 6]. Thirdly, this was a single‐center retrospective study, and the results may have been biased.…”

Section: Discussionmentioning

confidence: 99%

“…Currently, the commonly used anticoagulation methods in clinical practice include unfractionated heparin, low-molecular-weight heparin (LMWH), regional citrate anti-coagulation (RCA), or no anti-coagulation. Previous studies have shown that blood flow velocity [4], treatment [4] and hemodilution mode [5,6], and other factors, in addition to anticoagulant factors, are related to CRRT time. Different anti-coagulant infusion modes have an impact on CRRT time [3].…”

Section: Introductionmentioning

confidence: 99%

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Factors affecting continuous renal replacement therapy duration in critically ill patients: A retrospective study

Guo

Zeng

et al. 2023

Ther Apher Dial

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IntroductionThis study aimed to analyze the factors affecting continuous renal replacement therapy (CRRT) duration in critically ill patients and provide a reference for clinical treatment.Material and MethodsWe divided patients into regional citrate anti‐coagulation (RCA) and low‐molecular‐weight‐heparin (LMWH) groups according to the anti‐coagulation method and collected the relevant data, to analyze the factors associated with CRRT time.ResultsCompared with the LMWH group, the RCA group had a longer mean treatment time (55.36 ± 22.57 vs. 37.65 ± 27.09 h, p < 0.001), lower transmembrane pressure, and lower filter pressure, regardless of vascular access site. Multivariable linear regression analysis showed a significant correlation between anti‐coagulation patterns, filter pressure at CRRT discontinuation, nurses' level of intensive care unit experience, pre‐machine fibrinogen level, and CRRT time.ConclusionAnti‐coagulation is the most important factor affecting CRRT duration. Filter pressure, nurses' level of intensive care unit experience, and fibrinogen level also affecting CRRT duration.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Factors affecting continuous renal replacement therapy duration in critically ill patients: A retrospective study

Guo

Zeng

et al. 2023

Ther Apher Dial

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“…Continuous renal replacement therapy is an essential tool for the treatment of critically ill patients 27 ; however, the unplanned interruption of CRRT during treatment makes it impossible to deliver CRRT smoothly. This treatment interruption reduces the dose of CRRT, resulting in the inadequate control of uraemia, 28 which seriously affects the realisation of treatment goals and even disease prognosis. The unplanned interruption of CRRT can also lead to electrolyte disorders and body fluid imbalance in patients.…”

Section: Discussionmentioning

confidence: 99%

Meta-analysis of haematocrit and activated partial thromboplastin time as risk factors for unplanned interruptions in patients undergoing continuous renal replacement therapy

2023

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Objective: Although continuous renal replacement therapy (CRRT) is common, unplanned interruptions often limit its usefulness. Unplanned interruption refers to the forced interruption of blood purification treatment, the failure to complete blood purification treatment goals or the failure to meet blood purification schedule times. This study aimed to evaluate the effect of haematocrit and activated partial thromboplastin time (APTT) on the incidence of unplanned interruptions in critical patients with CRRT. Methods: A systematic review and a meta-analysis were performed by searching the databases of China National Knowledge Infrastructure, Wanfang, VIP, China Biomedical Literature, Cochrane Library, PubMed, Web of Science and Embase from their inception to 31st March 2022 for all studies with a comparator or independent variable relating to the unplanned interruption of CRRT. Results: Nine studies involving 1165 participants were included. Haematocrit and APTT were independent risk factors for the unplanned interruption of CRRT. The higher the haematocrit level, the greater the risk of unplanned CRRT interruptions (relative risk ratio [RR] = 1.04, 95% confidence interval [CI]: 1.02, 1.07, Z = 4.27, p < 0.001). The prolongation of APPT reduced the risk of unplanned CRRT interruptions (RR = 0.94, 95% CI: 0.92, 0.96, Z = 6.10, p < 0.001). Conclusion: Haematocrit and APTT are the influencing factors on the incidence of unplanned interruptions in critical patients undergoing CRRT.

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“…9 This study discussed the efficacy and safety of CVVH and CVVHDF, the two most utilised CRRT modalities in China’s PICUs combined with RCA, since this comparison has yet to be published for Chinese populations. Tsujimoto et al 10 analysed 20 studies involving 1143 patients receiving CRRT and found that filtre lifespan was longer with CVVHDF than with CVVH. A study on adult patients in the United Kingdom found that in non-septic patients requiring prolonged CRRT, CVVHDF reduced the incidence of filtre malfunctions, prolonged filtre lifespan, and had better efficacy than CVVH, 11 suggesting that CVVHDF may be a better option.…”

Section: Discussionmentioning

confidence: 99%

Comparison of different modalities of continuous renal replacement therapy with regional sodium citrate anticoagulation in paediatric patients

Xiao

Zhou

et al. 2022

Int J Artif Organs

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Background: To evaluate the efficacy and safety of continuous renal replacement therapy (CRRT) modalities with regional sodium citrate anticoagulation (RCA) in children. Methods: This retrospective study was conducted at the paediatric intensive care unit of Hunan Children’s Hospital in China. Medical records of paediatric patients hospitalised for RCA-CRRT between April 2017 and March 2021 were reviewed. Patients received continuous venovenous haemodialysis, continuous venovenous haemofiltration (CVVH), or continuous venovenous haemodiafiltration (CVVHDF). Results: Patients on continuous venovenous haemodialysis ( n = 2) were excluded because of their small sample size. The remaining participants were divided into CVVH and CVVHDF groups; 80 patients received CRRT, with 40 and 62 sessions in the CVVH and CVVHDF groups, respectively. The filtre lifespan was longer in the CVVHDF group than in the CVVH group (median value [interquartile range]; 47 [15] hours vs. 35 [17.5] hours; p = 0.029). Compared with the CVVHDF group, the hazard ratio for filtre lifespan in the CVVH group was 3.023 (95% confidence interval 1.820–5.023, p < 0.001). There were no significant differences in ionised calcium levels of the circuits between the two groups at different time points ( p < 0.05). Metabolic alkalosis, hyperlactataemia, hypocalcaemia, and hypercalcaemia occurred in both groups, with metabolic alkalosis being the most common complication. No patients in either group experienced sodium citrate accumulation or hypernatraemia. Inter-group differences in the incidence of these complications were not statistically significant ( p > 0.05). Conclusions: Our results suggest that CVVHDF is a better option for RCA-CRRT than CVVH.

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Non-pharmacological interventions for preventing clotting of extracorporeal circuits during continuous renal replacement therapy

Cited by 11 publications

References 146 publications

Factors affecting continuous renal replacement therapy duration in critically ill patients: A retrospective study

Factors affecting continuous renal replacement therapy duration in critically ill patients: A retrospective study

Meta-analysis of haematocrit and activated partial thromboplastin time as risk factors for unplanned interruptions in patients undergoing continuous renal replacement therapy

Comparison of different modalities of continuous renal replacement therapy with regional sodium citrate anticoagulation in paediatric patients

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