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Membrane pressures predict clotting of pediatric continuous renal replacement therapy circuits.
Kakajiwala, Aadil; Jemielita, Thomas; Hughes, John Z; Windt, Kimberly; Denburg, Michelle; Goldstein, Stuart L; Laskin, Benjamin.
Afiliação
  • Kakajiwala A; Department of Pediatrics, Division of Nephrology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA. kakajiwala_a@kids.wustl.edu.
  • Jemielita T; Department of Pediatrics, Division of Pediatric Nephrology, Washington University in St. Louis School of Medicine, Campus Box 8116, 660 Euclid Ave, St. Louis, MO, 63110, USA. kakajiwala_a@kids.wustl.edu.
  • Hughes JZ; Department of Biostatistics, University of Pennsylvania, Philadelphia, PA, USA.
  • Windt K; Drexel College of Medicine and Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA.
  • Denburg M; Department of Pediatrics, Division of Nephrology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
  • Goldstein SL; Department of Pediatrics, Division of Nephrology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
  • Laskin B; Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Pediatr Nephrol ; 32(7): 1251-1261, 2017 Jul.
Article em En | MEDLINE | ID: mdl-28247082
ABSTRACT

BACKGROUND:

Clotting of continuous renal replacement therapy (CRRT) circuits leads to inadequate clearance, decreased ultrafiltration, and increased resource use. We identified factors associated with premature clotting of circuits during CRRT in children.

METHODS:

In a retrospective cohort of 26 children (median age 11.8 years) receiving 79 CRRT circuits (51 heparin, 22 citrate, 6 using no anticoagulation), we captured hourly pressure, flow, and fluid removal rates along with all activated clotting time (ACT) and circuit ionized calcium measurements. Cox and logistic regression models were used to examine factors associated with premature circuit clotting before the scheduled 3-day circuit change.

RESULTS:

Of the 79 circuits, 51 (64.6%) underwent unplanned filter change due to filter clotting (median duration 18.25 h, interquartile range [IQR] 9.25, 33.5 h), and 28 (35.4%) underwent scheduled change (median duration 66 h, IQR 61.00, 69.00 h). Patient age, catheter size and location, blood flow rate, and the percentage of pre-filter replacement fluid were not associated with premature clotting. Heparin circuits were less likely than citrate circuits to clot prematurely. Each 1-mmHg increase in the transmembrane or filter pressure was independently associated with a 1.5% (95% confidence interval [CI] 1.0-2.0%) and 1.5% (95% CI 1.0-2.0%) higher risk of clotting, respectively. Higher ACTs were associated with lower transmembrane (p = 0.03) and filter (p < 0.001) pressures.

CONCLUSIONS:

The majority of circuits in our cohort were subject to unplanned filter changes. Elevated transmembrane and filter pressures were associated with clotting. Our results suggest that maintaining higher ACT may decrease the risk of circuit clotting. Larger studies are needed to examine other factors that may prolong the lifespan of the CRRT circuit in this high-risk population.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Pressão / Trombose / Diálise Renal / Membranas Artificiais / Anticoagulantes Tipo de estudo: Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adolescent / Child / Child, preschool / Female / Humans / Male Idioma: En Revista: Pediatr Nephrol Ano de publicação: 2017 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Pressão / Trombose / Diálise Renal / Membranas Artificiais / Anticoagulantes Tipo de estudo: Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adolescent / Child / Child, preschool / Female / Humans / Male Idioma: En Revista: Pediatr Nephrol Ano de publicação: 2017 Tipo de documento: Article