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Non-anticoagulation pediatric continuous renal replacement therapy methods to increase circuit life
Rupesh Raina1,2, Sidharth Sethi3, Amrit Khooblall1,2
1Akron Nephrology Associates, Cleveland Clinic Akron General Medical Center, Akron, Ohio, USA.
Hemodialysis International. International Symposium on Home Hemodialysis
|January 6, 2022
Summary
Non-anticoagulation strategies can prevent circuit clotting during continuous renal replacement therapy (CRRT). Utilizing nonthrombogenic materials, optimized blood flow, and biocompatible membranes reduces CRRT interruptions and bleeding risks.
Area of Science:
- Nephrology
- Critical Care Medicine
Background:
- Acute kidney injury (AKI) necessitates supportive treatment like continuous renal replacement therapy (CRRT).
- Circuit clotting is a primary cause of CRRT interruption, often necessitating anticoagulation.
- Anticoagulation carries an increased risk of bleeding, requiring careful management.
Purpose of the Study:
- To evaluate the effectiveness of non-anticoagulation measures in preventing circuit clotting during CRRT.
- To identify strategies that minimize CRRT interruptions without increasing bleeding risks.
Main Methods:
- A comprehensive literature search was performed using PubMed/Medline and Embase.
- Included studies focused on non-anticoagulation techniques for CRRT circuit patency.
Main Results:
- Nonthrombogenic, noncuffed, nontunneled catheters with separate lumens are optimal.
- Maintaining blood flow around 200 ml/min (adjusted for pediatrics) and monitoring hematocrit/platelets are crucial.
- Predilution and use of biocompatible membranes (e.g., polyacrylonitrile, polysulfone) reduce clotting.
Conclusions:
- Non-anticoagulation measures can effectively maintain CRRT circuit patency.
- These strategies allow for efficient CRRT without elevating bleeding risks.
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