A Method to Improve Continuous Renal Replacement Therapy Circuit Survival Time in Critically Ill Coronavirus Disease 2019 Patients With Acute Kidney Injury

Meint Volbeda; Mark Londema; Matijs van Meurs; Coen A Stegeman; Ron T Gansevoort; Stefan P Berger; Peter H J van der Voort; Casper F M Franssen

doi:10.1097/CCE.0000000000000258

A Method to Improve Continuous Renal Replacement Therapy Circuit Survival Time in Critically Ill Coronavirus Disease 2019 Patients With Acute Kidney Injury

Crit Care Explor. 2020 Oct 15;2(10):e0258. doi: 10.1097/CCE.0000000000000258. eCollection 2020 Oct.

Authors

Meint Volbeda¹, Mark Londema¹, Matijs van Meurs¹, Coen A Stegeman², Ron T Gansevoort², Stefan P Berger², Peter H J van der Voort¹, Casper F M Franssen²

Affiliations

¹ Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
² Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

Abstract

Objectives: Optimizing continuous renal replacement therapy circuit survival in coronavirus disease 2019 patients admitted to the ICU.

Design: Single-center prospective observational cohort study.

Setting: Tertiary academic teaching ICU.

Patients: Between March 19, 2020, and May 18, 2020, 11 out of 101 coronavirus disease 2019 patients were treated with continuous renal replacement therapy comprising 127 continuous renal replacement therapy days.

Interventions: A nonrandomized observational comparison of circuit anticoagulation modalities using standard regional citrate anticoagulation, continuous IV heparin anticoagulation, or the combination of regional citrate anticoagulation with either continuous IV heparin or therapeutic dose nadroparin.

Measurements and main results: Circuit patency was shorter than 24 hours using standard regional citrate anticoagulation or continuous IV heparin anticoagulation. Median circuit survival increased with at least 165% when the combination of regional citrate anticoagulation with either continuous IV heparin or therapeutic dose nadroparin was applied.

Conclusions: Continuous renal replacement therapy circuit patency is diminished in coronavirus disease 2019 ICU patients. Combining regional citrate anticoagulation with either continuous IV heparin or therapeutic dose nadroparin increases filter survival as compared with regional citrate anticoagulation alone in this nonrandomized observational study.

Keywords: acute kidney injury; anticoagulation; continuous renal replacement therapy; coronavirus disease 2019; critically ill.