Factors Associated with Hemofilter Clotting in Patients with Acute Kidney Injury Requiring Continuous Renal Replacement Therapy
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Abstract
Background: Hemofilter clotting compromises efficacy of continuous renal replacement therapy (CRRT). However, risk factors associated with filter clotting are not well characterized. Recently, a new calculation of filtration fraction (FF) which incorporates systemic and post-filter hematocrit into the formula (FFHct) has been purposed. This study aimed to evaluate the associations between FFHct, conventional FF, and other related factors with filter survival in patients receiving CRRT.
Method: This prospective cohort study was conducted in patients with acute kidney injury undergoing CRRT without anticoagulation. Factors related to filter clotting were documented at baseline and every 8 hours for 72 hours or until filter loss.
Results: Twenty-one patients using 48 filters were included. The median filter survival was 20.5 hours, and all filters clotted within 72 hours. In the multivariate analysis, the independent predictors for filter clotting were FFHct > 20% (HR: 2.18, 95% CI: 1.10 - 4.31, p=0.03), sites of dialysis catheter other than the right internal jugular vein (HR: 2.23, 95% CI: 1.16 - 4.29, p=0.02), and platelet count >100,000 /μl (HR: 2.22, 95% CI: 1.08 - 4.60, p=0.03). Arterial pressure circuit (<-150 mmHg), sieving coefficient (<0.9), conventional FF cut-off of (≥20%), and post-filter hematocrit (≥35%) were not associated with filter survival.
Conclusion: FFHct > 20% was an independent predictor of decreased filter lifespan in patients with acute kidney injury undergoing CRRT without anticoagulation. Future trials are needed to validate these preliminary findings.
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