Faster Blood Flow Rate Does Not Improve Circuit Life in Continuous Renal Replacement Therapy: A Randomized Controlled Trial

Fealy, Nigel; Aitken, Leanne M.; Toit, E. Du; Lo, Serigne; Baldwin, Ian

doi:10.1097/ccm.0000000000002568

Cited by 29 publications

(29 citation statements)

References 38 publications

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“…In our study, CVVHD at 100 mL/min blood flow was associated with longer circuit survival compared with CVVH at a median blood flow of 200 mL/ min. In addition, Fealy et al [18] found that shorter aPTT and higher platelet counts were associated with earlier crashing of the CRRT circuits, in line with our findings. A comparison of catheters used in this study was the object of a previous paper published by our group [19].…”

Section: Relationship To Previous Studiessupporting

confidence: 92%

“…It is thus possible that the higher blood flows typically used with CVVH might improve circuit lifespan and compensate for other circuit shortening effects of CVVH. However, more recently, Fealy et al [18] conducted a RCT of 2 different blood flow levels during CVVH and found no effect of blood flow on circuit lifespan. In our study, CVVHD at 100 mL/min blood flow was associated with longer circuit survival compared with CVVH at a median blood flow of 200 mL/ min.…”

Section: Relationship To Previous Studiesmentioning

confidence: 99%

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Circuit Survival during Continuous Venovenous Hemodialysis versus Continuous Venovenous Hemofiltration

et al. 2020

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Background: Continuous renal replacement therapy (CRRT) technique may affect circuit lifespan. A shorter circuit life may reduce CRRT efficacy and increase costs. Methods: In a before-and-after study, we compared circuit median survival time during continuous venovenous hemofiltration (CVVH) versus continuous venovenous hemodialysis ( CVVHD). We performed log-rank mixed effects univariate analysis and Cox mixed effect regression modeling to define predictors of circuit lifespan. Results: We compared 197 CVVHD and 97 CVVH circuits in 39 patients. There was no overall difference in circuit lifespan. When no anticoagulation was used, median circuit survival time was shorter for CVVH circuits (5 h, 95% CI 3-7 vs. 10 h, 95% CI 8-13, p < 0.01). Moreover, CVVHD, lower platelets levels, and longer activated partial thromboplastin time independently predicted longer circuit median survival time. Conclusions: CVVHD is associated with longer circuit median survival time than CVVH when no anticoagulation is used and is an independent predictor of circuit survival.

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Section: Relationship To Previous Studiessupporting

confidence: 92%

Section: Relationship To Previous Studiesmentioning

confidence: 99%

Circuit Survival during Continuous Venovenous Hemodialysis versus Continuous Venovenous Hemofiltration

et al. 2020

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“…The time associated with the opposing treatment on-time is known as the circuit or filter life [1,3,[5][6][7][8][9], and although foundation literature and consensus groups provide definitions and nomencla-Blood Purif 2020;49:490-495 DOI: 10.1159/000505260 ture for CRRT [6,7,10], no specific definition is provided for this key treatment variable. Many studies investigating and reporting CRRT methods for anticoagulation report this data as filter or circuit life (hours), and two recent studies provide a clearer definition in their methods citing high transmembrane pressure, visible clot, and or inability to operate the blood pump and therapy stopping [11,12] as indicators reflecting clotting or clogging (the mechanism). They are associated criteria for ceasing CRRT and the life or cumulative time since the circuit started measured in hours.…”

Section: Introductionmentioning

confidence: 99%

Continuous Renal Replacement Therapy Without Anticoagulation: Top Ten Tips to Prevent Clotting

et al. 2020

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Continuous renal replacement therapy (CRRT) is intended to function continuously and is prescribed for this outcome. Anticoagulants may not always be used. Clotting and clogging within the CRRT filter stopping therapy occurs with a variability in the total elapsed time associated. This is commonly known as the circuit or filter "life". It is very useful and important to record this time at the bedside and refer to this as a measure of success and quality. Filter life (i.e., hours) is reported in many reports investigating CRRT but is not well understood or clear for when this is considered inadequate and clinical review strategies should be considered. Failure before 8 h could be associated with inadequate renal support and "therapy". Anticoagulation is the key intervention to prolong filter function; however, the extracorporeal circuit design and set up, access catheter profile and insertion site, CRRT machine settings, and the human interface operating CRRT are always important and the only consideration to prevent failure when no anticoagulation is mandated for CRRT.

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“…Rajajee et al [3] considered acute liver failure patients typically coagulopathic and at risk for intracranial hemorrhage. Fealy et al [4] associated the decreased platelet count (hazards ratio, 1.19; p = 0.03) with a reduced likelihood of circuit clotting repeated events in critically ill adults requiring continuous renal replacement therapy. Muzaffar et al [5] could differentiate among normo coagulant, hypo coagulant, hyper coagulant states by thromboelastography unlike conventional coagulation assay which estimated the platelet count at 153.96±99.16 (×10 ).…”

Section: Discussionmentioning

confidence: 99%

Investigation of the Opposite Capacities of Erythropoietin and U-74389G on Platelet Crit Levels

Tsompos¹

2017

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Aim: This study calculated the opposite capacities of 2 drugs: the erythropoietin (Epo) and the antioxidant drug U-74389G. The calculation was based on the results of 2 preliminary studies, each one of which estimated the platelet crit (PCT) levels alterations, after the respective drug usage in an induced hypoxia reoxygenation animal experiment. Materials and methods:The 2 main experimental endpoints at which the PCT levels (PCTl) were evaluated were the 60th reoxygenation min (for the groups A, C and E) and the 120th reoxygenation min (for the groups B, D and F). Specially, the groups A and B were processed without drugs, groups C and D after Epo administration; whereas groups E and F after U-74389G administration. Results:The first preliminary study of Epo non significantly decreased the PCTl by 6.88% ± 3.69% (p-value=0.0615). Also, the second preliminary study of U-74389G non-significantly increased the PCTl by 6.73% ± 37.45% (p-value=0.0712). These 2 studies were co-evaluated since they came from the same experimental setting. The outcome of the co-evaluation was that U-74389G has opposite acute effect than Epo (p-value=0.0000). Conclusion:The anti-oxidant capacities of U-74389G enhance the acute increasing properties on PCTl than epo (p-value=0.0000).

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Faster Blood Flow Rate Does Not Improve Circuit Life in Continuous Renal Replacement Therapy: A Randomized Controlled Trial

Abstract: There was no difference in circuit life whether using blood flow rates of 250 or 150 mL/min during continuous renal replacement therapy.

Cited by 29 publications

References 38 publications

Circuit Survival during Continuous Venovenous Hemodialysis versus Continuous Venovenous Hemofiltration

Circuit Survival during Continuous Venovenous Hemodialysis versus Continuous Venovenous Hemofiltration

Continuous Renal Replacement Therapy Without Anticoagulation: Top Ten Tips to Prevent Clotting

Investigation of the Opposite Capacities of Erythropoietin and U-74389G on Platelet Crit Levels

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