Meta-analysis of haematocrit and activated partial thromboplastin time as risk factors for unplanned interruptions in patients undergoing continuous renal replacement therapy
Restricted accessResearch articleFirst published online September, 2023
Meta-analysis of haematocrit and activated partial thromboplastin time as risk factors for unplanned interruptions in patients undergoing continuous renal replacement therapy
Although continuous renal replacement therapy (CRRT) is common, unplanned interruptions often limit its usefulness. Unplanned interruption refers to the forced interruption of blood purification treatment, the failure to complete blood purification treatment goals or the failure to meet blood purification schedule times. This study aimed to evaluate the effect of haematocrit and activated partial thromboplastin time (APTT) on the incidence of unplanned interruptions in critical patients with CRRT.
Methods:
A systematic review and a meta-analysis were performed by searching the databases of China National Knowledge Infrastructure, Wanfang, VIP, China Biomedical Literature, Cochrane Library, PubMed, Web of Science and Embase from their inception to 31st March 2022 for all studies with a comparator or independent variable relating to the unplanned interruption of CRRT.
Results:
Nine studies involving 1165 participants were included. Haematocrit and APTT were independent risk factors for the unplanned interruption of CRRT. The higher the haematocrit level, the greater the risk of unplanned CRRT interruptions (relative risk ratio [RR] = 1.04, 95% confidence interval [CI]: 1.02, 1.07, Z = 4.27, p < 0.001). The prolongation of APPT reduced the risk of unplanned CRRT interruptions (RR = 0.94, 95% CI: 0.92, 0.96, Z = 6.10, p < 0.001).
Conclusion:
Haematocrit and APTT are the influencing factors on the incidence of unplanned interruptions in critical patients undergoing CRRT.
LiLLiXXiaY, et al. Recommendation of antimicrobial dosing optimization during continuous renal replacement therapy. Front Pharmacol2020; 11: 786.
2.
FernándezSNSantiagoMJGonzálezR, et al. Changes in hemodynamics, renal blood flow and urine output during continuous renal replacement therapies. Sci Rep2020; 10(1): 20797.
3.
RicciZRomagnoliSRoncoC, et al. From continuous renal replacement therapies to multiple organ support therapy. Contrib Nephrol2018; 194: 155–169.
4.
ThongprayoonCCheungpasitpornWAhmedA H.Trends in the use of renal replacement therapy modality in intensive care unit: a 7 year study. Ren Fail2015; 37(9): 1444–1447.
5.
KongGWuJChuH, et al. Predicting prolonged length of hospital stay for peritoneal dialysis-treated patients using stacked generalization: model development and validation study. JMIR Med Inform2021; 9(5): e17886.
6.
HoKMMorganDJ.Patient factors associated with frequent clotting of dialysers during haemodiafiltration in critically ill patients: a post hoc analysis of a randomised controlled study. Anaesth Intensive Care2014; 42(1): 59–64.
7.
HeiseDGriesDMoererO, et al. Predicting restoration of kidney function during CRRT-free intervals. J Cardiothorac Surg2012; 7: 6.
8.
BrainMWinsonERoodenburgO, et al. Non anti-coagulant factors associated with filter life in continuous renal replacement therapy (CRRT): a systematic review and meta-analysis. BMC Nephrol2017; 18(1): 69.
9.
SinghS.Anticoagulation during renal replacement therapy. Indian J Crit Care Med2020; 24(Suppl. 3): S112–S116.
10.
TsujimotoHTsujimotoYNakataY, et al. Pharmacological interventions for preventing clotting of extracorporeal circuits during continuous renal replacement therapy. Cochrane Database Syst Rev2020; 3(3): CD012467
11.
YasudaHUchinoSUjiM, et al. The lower limit of intensity to control uremia during continuous renal replacement therapy. Crit Care2014; 18(5): 539.
12.
BellomoRCassAColeL, et al. Intensity of continuous renal-replacement therapy in critically ill patients. N Engl J Med2009; 361(17): 1627–1638.
13.
JhaVAriciMCollinsAJ, et al. Understanding kidney care needs and implementation strategies in low- and middle-income countries: conclusions from a “Kidney Disease: Improving Global Outcomes” (KDIGO) controversies conference. Kidney Int2016; 90(6): 1164–1174.
14.
KhwajaA.KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract2012; 120(4): c179–c184.
15.
VesconiSCruzDNFumagalliR, et al. Delivered dose of renal replacement therapy and mortality in critically ill patients with acute kidney injury. Crit Care2009; 13(2): R57.
16.
DaugirdasJTBlakePGIngTS. Handbook of dialysis, 5th ed.J Vasc Access2015; 72(6): 322–322.
17.
StangA.Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol2010; 25(9): 603–605.
18.
VieraAJ.Odds ratios and risk ratios: what’s the difference and why does it matter?South Med J2008; 101(7): 730–734.
19.
CalifanoAMBitkerLBaldwinI, et al. Circuit survival during continuous venovenous hemodialysis versus continuous venovenous hemofiltration. Blood Purif2020; 49(3): 281–288.
20.
FuXLiangXSongL, et al. Building and validation of a prognostic model for predicting extracorporeal circuit clotting in patients with continuous renal replacement therapy. Int Urol Nephrol2014; 46(4): 801–807.
21.
ZhangZNiHLuB.Variables associated with circuit life span in critically ill patients undergoing continuous renal replacement therapy: a prospective observational study. ASAIO J, 2012; 58(1): 46–50.
22.
ChenJSSongMYangSY.Influencing factors of unplanned withdrawing machine in patients with severe CRRT in ICU. China Medical Herald2021; 30: 92–95.
23.
LiHJSuL, et al. Related factors of unexpected interruption of continuous renal replacement therapy in critical care patients. Chin J Blood Purif2020; 19(9): 4.
24.
SongLFuXQuanZL, et al. Analysis on related factors of cardiopulmonary bypass clogged in patients undergoing continuous renal replacement therapy. Chin Nurs Res2015; 29(13): 1608–1612.
25.
WangYY.Study on influencing factors of unplanned departure of continuous renal replacement therapy patients in ICU. Thromb Hemost2020; 26(1): 3.
26.
ZhangZHZengTYXuR.Analysis on related factors of unplanned interruption during continuous renal replacement therapy without anticoagulation. Jl Nurs Train2019; 34(18): 7.
27.
PaskoDAChurchwellMDSalamaNN, et al. Longitudinal hemodiafilter performance in modeled continuous renal replacement therapy. Blood Purif2011; 32(2): 82–88.
28.
TsujimotoYMikiSShimadaH, et al. Non-pharmacological interventions for preventing clotting of extracorporeal circuits during continuous renal replacement therapy. Cochrane Database Syst Rev2019; 9(9): CD013330.
29.
FujiiTUchinoSDoiK, et al.; JAKID Study Group. Diagnosis, management, and prognosis of patients with acute kidney injury in Japanese intensive care units: the JAKID study. J Crit Care2018; 47: 185–191.
30.
GattasDJRajbhandariDBradfordC, et al. A randomized controlled trial of regional citrate versus regional heparin anticoagulation for continuous renal replacement therapy in critically ill adults. Crit Care Med2015; 43(8): 1622–1629.
31.
JuncosL AChandrashekarKKarakalaN, et al. Vascular access, membranes and circuit for CRRT. Semin Dial2021; 34(6): 406–415.
32.
KimIBFealyNBaldwinI, et al. Insertion side, body position and circuit life during continuous renal replacement therapy with femoral vein access. Blood Purif2011; 31(1–3): 42–46.
33.
JoannidisMOudemans-Van StraatenHM.Clinical review: patency of the circuit in continuous renal replacement therapy. Crit Care2007; 11(4): 218.
34.
GeddesJBCarrRTWuF, et al. Blood flow in microvascular networks: a study in nonlinear biology. Chaos2010; 20(4): 045123.
35.
LeeSWJoJYKimWJ, et al. Patient and haemodynamic factors affecting intraoperative graft flow during coronary artery bypass grafting: an observational pilot study. Sci Rep2020; 10(1): 12968.
36.
BaldwinIJonesDCartyP, et al. Continuous renal replacement therapy without anticoagulation: top ten tips to prevent clotting. Blood Purif2020; 49(4): 1–6.
37.
BentoDLopesSMaiaI, et al. Bubbles moving in blood flow in a microchannel network: the effect on the local hematocrit. Micromachines2020; 11(4): 344.
38.
HartmannSBiliourisKLeskoLJ, et al. Quantitative systems pharmacology model-based predictions of clinical endpoints to optimize warfarin and rivaroxaban anti-thrombosis therapy. Front Pharmacol2020; 11: 1041.
39.
YeeJKaideCG.Emergency reversal of anticoagulation. West J Emerg Med2019; 20(5): 770–783.
40.
KamalAHTefferiAPruthiRK.How to interpret and pursue an abnormal prothrombin time, activated partial thromboplastin time, and bleeding time in adults. Mayo Clin Proc2007; 82(7): 864–873.
41.
WuYLiYLangeEM, et al. Genome-wide association study for adiponectin levels in Filipino women identifies CDH13 and a novel uncommon haplotype at KNG1-ADIPOQ. Hum Mol Genet2010; 19(24): 4955–4964.
42.
AnkawiGNeriMZhangJ, et al. Extracorporeal techniques for the treatment of critically ill patients with sepsis beyond conventional blood purification therapy: the promises and the pitfalls. Crit Care2018; 22(1): 262.
43.
ZarbockAKüllmarMKindgen-MillesD, et al. Effect of regional citrate anticoagulation vs systemic heparin anticoagulation during continuous kidney replacement therapy on dialysis filter life span and mortality among critically ill patients with acute kidney injury: a randomized clinical trial. JAMA2020; 324(16): 1629–1639.
44.
HikinoKKoidoMIdeK, et al. Individual variation in unfractionated heparin dosing after pediatric cardiac surgery. Sci Rep2020; 10(1): 19438.
45.
BaiMZhouMHeL, et al. Citrate versus heparin anticoagulation for continuous renal replacement therapy: an updated meta-analysis of RCTs. Intensive Care Med2015; 41(12): 2098–2110.
