A Role of Circuit Clotting and Strategies to Prevent It during Blood Purification Therapy with oXiris Membrane: An Observational Multicenter Study

Abstract

<b><i>Introduction:</i></b> Membrane fouling is a significant complication potentially reducing clinical effects of extracorporeal blood purification (EBP) in critically ill septic patients with acute kidney injury. Although fascinating, the effect of heparin coating in preventing membrane fouling is currently unknown. This multicenter prospective study aims to preliminary describe the incidence, associated factors, and clinical consequences of premature circuit clotting in a cohort of adult critically ill septic patients treated with EBP using a high biocompatible heparin-coated hemodiafilter characterized by advanced adsorption properties. <b><i>Methods:</i></b> This study was a retrospective analysis of prospectively entered data in the oXirisNet Registry; overall, 97 septic patients undergoing EBP with oXiris between May 2019 and March 2020 were enrolled in this study. Patients were divided into two groups according to the occurrence of filter clotting (premature vs. nonpremature). Logistic regression analysis was used to identify factors associated with premature circuit clotting. <b><i>Results:</i></b> Premature clotting occurred in 18 (18.6%) patients. Results of the multivariate logistic regression analysis demonstrated that hematocrit (<i>p</i> = 0.02, odds ratio [OR] 1.15 [1.05; 1.30]), serum procalcitonin (PCT) (<i>p</i> = 0.03, OR 1.1 [1.05; 1.2]), and anticoagulation strategy (<i>p</i> = 0.05 at Wald’s test) were independent predictors of circuit clotting. Systemic anticoagulation (<i>p</i> = 0.02, OR 0.03 [0.01; 0.52]) and regional citrate anticoagulation (<i>p</i> = 0.10, OR 0.23 [0.04; 1.50]) were both protective factors if compared to no-anticoagulation strategy. Patients with nonpremature circuit clotting showed more rapid recovery from hemodynamic instability, pulmonary hypo-oxygenation, and electrolyte disorders and greater improvement of inflammatory markers and SOFA scores. <b><i>Conclusion:</i></b> Although in this study the incidence of premature circuit clotting was relatively low (18.6%) compared to previously reported values (54%), membrane clotting in adult critically ill septic patients could cause clinically relevant interferences with treatment performances. Prevention of clotting should be based on avoiding higher patients’ hematocrit, high serum PCT, and no-anticoagulation strategy which resulted as independent predictors of circuit clotting.

Implementation of a coagulation component into a phosphate kinetics model in haemodialysis therapy: A tool for detection of clotting problems?

“…Furthermore, in the present study, the haemoconcentration was not sampled systematically during the data collection and it was, therefore, not possible to include this parameter in the model. Further studies should aim at describing the effect of haemoconcentration independently, because this would be a step closer to correct interpretation of the meaning of the estimated decrease in phosphate clearance (Abdulla et al., 2020 ; Pstras et al., 2019 ; Villa et al., 2022 ).…”

Regional citrate anticoagulation (RCA) in critically ill patients undergoing renal replacement therapy (RRT): expert opinion from the SIAARTI-SIN joint commission

“…Finally, about the emerging adjuvant therapies for sepsis and septic shock, few studies have investigated the feasibility and safety of RCA to optimize the use of specific devices for these techniques (e.g., polymyxin-B hemoperfusion, oXiris membrane, cytokines hemoadsorption devices) [72][73][74]; due to the limited experience, further studies are needed to allow recommendation in this particular setting.…”

A predictive model for the unplanned interruption during continuous renal replacement therapy: a retrospective observational study

“…For the multivariate analysis, a planned interruption was assigned a value of zero and an unplanned interruption was assigned a value of one. Some possible independent variables of the predictive model were identi ed and included in our study based on clinical experience and reviewing relevant literature: (1) age (year) [12]; (2) gender (male or female) [13]; (3) chronic diseases [yes or no, such as diabetes mellitus, chronic obstructive pulmonary disease (COPD), chronic heart failure (CHF), hypertension, and malignant tumor] [13]; (4) vascular access location (from femoral vein, jugular vein, or subclavian vein) [14]; (5) the blood puri cation catheter function (well or bad) [14]; (6) relevant blood test results before CRRT initiation [hematocrit (HCT), platelet (PLT), triglyceride, activated partial thromboplastin time (APTT), pH, and ionized calcium] [13,[15][16][17][18][19]; (7) the anticoagulation strategy (systemic anticoagulation such as heparin anticoagulation and low molecular heparin anticoagulation, or regional anticoagulation such as citrate anticoagulation and nafamostat mesylate anticoagulation) [20]; (8) the blood ow rate (ml/min) [21]; (9) pre-dilution or dialysis [21]; (10) post-dilution (yes or no) [22]; (11) the ltration fraction (%); ( 12) the frequency of blood pump stops (time) (Table 1). It should be pointed out that the blood ow rate, pre-dilution or dialysis, postdilution, and the ltration fraction are all adjusted at any time depending on the therapeutic goal.…”