Background: The current practice involves blood sampling from the circuit line to measure acid-base and electrolyte parameters during continuous renal replacement therapy (CRRT). However, there is limited evidence supporting its reliability due to the effects of anticoagulant mechanism and access recirculation associated with regional citrate anticoagulation (RCA).Aim: To evaluate the reliability of monitoring acid-base and electrolyte parameters through circuit lines in regular and reversed connections during RCA-CRRT. Study design:In this prospective cohort study, we included critically ill patients receiving RCA-CRRT via a double-lumen catheter. During the second hour after CRRT initiation, we collected blood samples to monitor acid-base and electrolyte parameters and their levels were compared between samples from the circuit lines (at 0, 3, and 5 minutes) and those from the central venous catheter (CVC) line (at 0 minute). During this time, CRRT switched to the replacement state as controls. Results:We observed 128 CRRT circuits in 60 adult patients receiving RCA-CRRT.Ninety-eight (76.6%) circuits had regular connections, while 30 (23.4%) had reversed connections. Among regular connections, no differences were observed in any acidbase or electrolyte parameters between samples from the CVC line and those from the circuit line at all time points (P > .05). Among reversed connections, ionized calcium levels were dramatically decreased at all three time points in samples from the circuit line compared with those from the CVC line (0.65 ± 0.12, 0.72 ± 0.11, and 0.78 ± 0.99 vs 0.98 ± 0.07 mmol/L, P < .001), with comparable levels of other acidbase or electrolyte parameters between the sampling patterns (P > .05).Conclusions: Acid-base and electrolyte parameters could be reliably monitored through the circuit line during RCA-CRRT in regular connections. However, in reversed connections, pre-filter ionized calcium concentrations determined through the circuit line were lower than those determined through the CVC line.

Chronic kidney disease (CKD) is a significant physical and economic burden all over the world. The prevalence of CKD was 10% in China (Bikbov et al., 2020), it was higher in China's southwest region (18.3%), and more than 50% of China's CKD patients were female (Wang, Yang, et al., 2019;Zhang et al., 2012). CKD patients could experience a series of physical symptoms, psychological problem, and changes in lifestyle (Lin et al., 2017). Further, as kidneys are important to be pregnancy, the associated risks of pregnancy increase

BackgroundCircuit clotting remains a major problem during continuous kidney replacement therapy (CKRT), particularly in patients with contraindications to anticoagulant use. We hypothesized that the different options of alternative replacement fluid infusion sites might affect circuit lifespan. However, research‐based evidence supporting an optimal replacement fluid infusion strategy is limited. Therefore, we aimed to evaluate the effect of three dilution modes (pre‐dilution, post‐dilution, and pre‐ to post‐dilution) on circuit lifespan during continuous veno‐venous hemodiafiltration (CVVHDF).MethodsThis prospective cohort study was conducted between December 2019 and December 2020. Patients requiring CKRT were enrolled to receive pre‐dilution, post‐dilution, or pre‐ to post‐dilution fluid infusion with CVVHDF. The primary endpoint was circuit lifespan, and the secondary outcomes included the clinical parameters of patients, such as changes in serum creatinine (Scr) and blood urea nitrogen (BUN) levels, 28‐day all‐cause mortality, and length of stay. For all patients included in this study, only the first circuit used was recorded.ResultsAmong the 132 patients enrolled in this study, 40 were in the pre‐dilution mode, 42 were in the post‐dilution mode, and 50 were in the pre‐ to post‐dilution mode. The mean circuit lifespan was significantly longer in the pre‐ to post‐dilution group (45.72 h, 95% CI, 39.75–51.69 h) than in the pre‐dilution group (31.58 h, 95% CI, 26.33–36.82 h) and the post‐dilution group (35.20 h, 95% CI, 29.62–40.78 h). There was no significant difference between the pre‐ and post‐dilution group circuit lifespan (p > 0.05). Kaplan–Meier survival analysis revealed a significant difference between the three dilution modes (p = 0.001). No significant differences were observed in terms of changes in the Scr and BUN levels, admission day, and 28‐day all‐cause mortality among the three dilution groups (p > 0.05).ConclusionThe pre‐ to post‐dilution mode significantly prolonged circuit lifespan but did not reduce Scr and BUN levels, compared with the pre‐dilution and post‐dilution modes during CVVHDF when no anticoagulants were used.