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

Area of Science:

• Nephrology
• Critical Care Medicine

Background:

• Continuous renal replacement therapy (CRRT) is vital for critically ill patients.
• Filter clotting, or reduced filter life, is a common issue impacting CRRT efficacy.
• Anticoagulation is often used to prevent filter clotting, but not always mandated.

Purpose of the Study:

• To highlight the importance of filter life as a metric for CRRT quality.
• To define inadequate filter life and suggest clinical review triggers.
• To explore factors influencing filter life beyond anticoagulation.

Main Methods:

• Review of CRRT operational parameters and outcomes.
• Analysis of factors contributing to premature filter clotting.
• Correlation of filter life with therapy adequacy.

Main Results:

• Filter life is a key indicator of CRRT success and quality.
• Filter failure before 8 hours may signal inadequate renal support.
• Circuit design, anticoagulation, access, machine settings, and operator interface all impact filter longevity.

Conclusions:

• Filter life is an essential, yet often poorly understood, metric in CRRT.
• Premature filter failure (before 8 hours) warrants clinical review.
• Optimizing extracorporeal circuit parameters and operator management is critical for maximizing filter life, especially when anticoagulation is not used.