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Regional citrate and systemic heparin are adequate to maintain filter half-life for COVID-19 patients on continuous

Cassandra Chiao1, Hilary Faust1, Tripti Singh1

  • 1Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA.

Seminars in Dialysis
|February 10, 2022
PubMed

Insights

Continuous renal replacement therapy (CRRT) filter clotting was similar in patients with COVID-19-associated acute kidney injury (AKI) versus septic shock-associated AKI. Optimal anticoagulation strategies for CRRT in COVID-19 patients require further investigation.

Area of Science:

  • Nephrology
  • Critical Care Medicine
  • Infectious Diseases

Background:

  • Acute kidney injury (AKI) is a common complication in critically ill patients, particularly those with COVID-19 and septic shock.
  • Continuous renal replacement therapy (CRRT) is frequently used to manage AKI in these patient populations.
  • Filter clotting is a significant challenge in CRRT, potentially impacting treatment efficacy and resource utilization.

Purpose of the Study:

  • To compare the incidence and characteristics of CRRT filter clotting between patients with COVID-19-associated AKI and those with septic shock-associated AKI.
  • To evaluate the impact of different anticoagulation strategies on CRRT filter lifespan in these patient groups.

Main Methods:

  • A retrospective study was conducted on adult ICU patients requiring CRRT for AKI.
  • Patients were categorized into two groups: COVID-19-associated AKI and septic shock-associated AKI.
  • Statistical analyses included independent t-tests, chi-square tests, and Kaplan-Meier curves to compare CRRT filter clotting and lifespan.

Main Results:

  • No significant difference was observed in CRRT hemofilter half-life between COVID-19 and non-COVID-19 septic shock patients (27.4 vs. 27.5 hours, p=0.79).
  • The daily rate of CRRT hemofilter changes was also similar between the groups (0.6 changes/day, p=0.84).
  • A higher proportion of COVID-19 patients received systemic heparin compared to septic shock patients (69% vs. 13%, p=0.02).

Conclusions:

  • CRRT filter lifespan and clotting rates were comparable between COVID-19-associated AKI and sepsis-associated AKI patients, even with varying anticoagulation methods.
  • Further research is necessary to determine the optimal anticoagulation strategies for CRRT in COVID-19 patients with AKI.
Abstract

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