Circuit haemodynamics during non-citrate and regional citrate continuous renal replacement, and impact of blood flow on filter life

Author:

Sansom Benjamin12ORCID,Udy Andrew34,Sriram Shyamala1,Presneill Jeffrey12,Bellomo Rinaldo1245

Affiliation:

1. Department of Intensive Care, The Royal Melbourne Hospital, Parkville, Melbourne, VIC, Australia

2. Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia

3. Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, VIC, Australia

4. Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia

5. Department of Intensive Care, The Austin, Melbourne, VIC, Australia

Abstract

Background: During continuous renal replacement therapy (CRRT) with regional citrate anticoagulation (RCA), blood flow (Qb) might affect vascular access dysfunction (AD) and, thereby, circuit life. Methods: Circuit life and circuit haemodynamics were studied in three intensive care units (ICUs) by analysing hemofilter device data (Prismaflex®, Baxter, Chicago, IL). The three sites shared similar RCA protocols but differed in Qb (120–130 vs 150–200 mL/h). Non-RCA circuits were compared with RCA circuits in which the impact of Qb was also assessed. Results: About 3,981,906 min of circuit pressures were analysed in 2568 circuits in 567 patients. High-Qb RCA was associated with more extreme pressures, and greater AD (IRR 3.7 (1.93–7.08) as well as reduced filter life 21.1 (10.2–42.6) vs 27.0 (14.8–41.6) h). AD in high-Qb RCA circuits was associated with a 49% reduction in filter life, versus 24% reduction in low-Qb RCA, associated with a rise in the rate of increase in transfilter pressure. Conclusions: High-Qb RCA-CRRT was associated with greater access dysfunction, earlier filter loss and increased haemodynamic impacts of access dysfunction, suggesting low-Qb RCA-CRRT may improve circuit mechanics, function and longevity.

Publisher

SAGE Publications

Subject

Biomedical Engineering,Biomaterials,General Medicine,Medicine (miscellaneous),Bioengineering

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