Filter lifespan in critically ill adults receiving continuous renal replacement therapy: the effect of patient and treatment-related variables

Dunn, Wendy J.; Sriram, Shyamala

doi:10.1016/s1441-2772(23)01477-1

Cited by 5 publications

(3 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Fealy et al [26] reported in a randomized controlled trial that longer APTT and decreased PLT count were independently associated a reduced likelihood of circuit clotting. The similar association of APTT [32] and PLT count [33,34] with CRRT filter lifespan were reported in observational studies as well. Zhang et al [35] reported that lower pH was significantly associated with longer filter lifespan in a multivariable Cox regression model.…”

Section: Discussionsupporting

confidence: 84%

Development and External Validation of a Model for Predicting Sufficient Filter Lifespan in Anticoagulation-Free Continuous Renal Replacement Therapy Patients

et al. 2021

View full text Add to dashboard Cite

Background: Anticoagulation-free continuous renal replacement therapy (CRRT) was recommended by the current clinical guideline for patients with increased bleeding risk and contraindications of citrate. Nevertheless, anticoagulation-free CRRT yielded heterogeneous filter lifespan. Furthermore, the specific cutoff values for traditional coagulation parameters to predict sufficient filter lifespan of anticoagulation-free CRRT have not yet been determined. The purpose of our present study was to develop and validate a model for predicting sufficient filter lifespan in anticoagulation-free CRRT patients. Methods: Patients who underwent anticoagulation-free CRRT in our center between June 2013 and June 2019 were retrospectively included. The primary outcome was sufficient filter lifespan (≥24 h). Thirty-seven predictors were included for modeling based on their clinical significance and previous reports. The final model was developed by using multivariable logistic regression analysis and was validated in a separate external cohort. Results: The development cohort included 170 patients. Sufficient filter lifespan was observed in 80 patients. Thirteen variables were independent predictors for sufficient filter lifespan by logistic regression: body temperature, mean arterial pressure, activated partial thromboplastin time, direct bilirubin, alkaline phosphatase, blood urea nitrogen, vasopressor use, body mass index, white blood cell, platelet count, D-dimer, uric acid, and pH. The area under the curve (AUC) of the stepwise model and internal validation model was 0.82 (95% confidence interval [CI] [0.76–0.88]) and 0.8 (95% CI [0.74–0.87]), respectively. The positive predictive value and the negative predictive value of the stepwise model were 0.77 and 0.79, respectively. The validation cohort included 44 eligible patients and the AUC of the external validation model was 0.82 (95% CI [0.69–0.96]). Conclusions: The use of a prediction model instead of an assessment based only on coagulation parameters could facilitate the identification of the patients with filter lifespan of ≥24 h when they accepted anticoagulation-free CRRT.

show abstract

Section: Discussionsupporting

confidence: 84%

Development and External Validation of a Model for Predicting Sufficient Filter Lifespan in Anticoagulation-Free Continuous Renal Replacement Therapy Patients

et al. 2021

View full text Add to dashboard Cite

show abstract

“…There is no consensus on the relationship between platelet count and filter lifespan in various studies. Some studies suggest that a lower platelet count is associated with an extended filter lifespan, 23 while others propose that an elevated platelet count above 45 × 10 9 /L increases the risk of filter clotting. 24 However, prospective observational studies have found no significant correlation between platelet count and circuit lifespan.…”

Section: Discussionmentioning

confidence: 99%

“…Another retrospective observational study also did not find any correlation between APTT and filter life-span. 23 However, a meta-analysis suggested a positive association between APTT and filter lifespan, although the evidence level for this finding was rated as “LOW” by the meta-analysis itself. 26 Therefore, further prospective controlled studies are needed to validate whether differences in platelet count and APTT levels between the two groups in this study would affect filter performance.…”

Section: Discussionmentioning

confidence: 99%

Citrate anticoagulation in plasma exchange followed by continuous renal replacement therapy in critically ill children

Xinping,

Jie,

Zhenya

et al. 2024

Int J Artif Organs

View full text Add to dashboard Cite

Objective: To investigate the effectiveness and safety of regional citrate-anticoagulated (RCA) plasma exchange (PE) and whether citrate-related metabolic disorders can be improved by sequential RCA continuous renal replacement therapy (CRRT). Methods: This retrospective, single-center observational study included 79 critically ill children requiring PE followed by CRRT (June 2018 to June 2021) at the Pediatric Intensive Care Unit of Hunan Children’s Hospital, China. Patients were divided into the RCA-PE ( n = 30) and systemic heparin anticoagulation (SHA-PE) ( n = 49) groups. Filter level comparison post-PE assessed RCA-PE efficacy, and metabolic changes occurring pre- and post-PE and CRRT were used to evaluate the effect of CRRT on RCA-based anticoagulation safety. Results: The RCA-PE group had a better overall filter performance than the SHA-PE group. Two hours after PE, pH and HCO₃− levels increased more significantly for the RCA-PE than the SHA-PE group. The RCA-PE incidence of metabolic alkalosis was 48.3%, higher by 4.2% ( p < 0.001) compared to the SHA-PE group. In the RCA-PE group, pH and HCO₃− decreased significantly 4 h after CRRT; the metabolic alkalosis caused by RCA-PE decreased to 13.8% ( p = 0.005). No significant difference in pH, HCO₃−, and metabolic alkalosis incidence was observed between the two groups 4 h after CRRT. Conclusions: The overall filtration performance of RCA-PE is superior to that of SHA-PE followed by CRRT. The metabolic complications associated with RCA-PE are mainly metabolic alkalosis that can be improved by using CRRT after RCA-PE and this is a better alternative for anticoagulation during PE in critically ill children.

show abstract

Risk factors for unplanned weaning of continuous renal replacement therapy in ICU patients: a meta-analysis

Zeng,

Shen,

Wan

et al. 2024

Renal Failure

View full text Add to dashboard Cite

Filter lifespan in critically ill adults receiving continuous renal replacement therapy: the effect of patient and treatment-related variables

Cited by 5 publications

References 23 publications

Development and External Validation of a Model for Predicting Sufficient Filter Lifespan in Anticoagulation-Free Continuous Renal Replacement Therapy Patients

Development and External Validation of a Model for Predicting Sufficient Filter Lifespan in Anticoagulation-Free Continuous Renal Replacement Therapy Patients

Citrate anticoagulation in plasma exchange followed by continuous renal replacement therapy in critically ill children

Risk factors for unplanned weaning of continuous renal replacement therapy in ICU patients: a meta-analysis

Contact Info

Product

Resources

About