#5409 FACTORS ASSOCIATED WITH THE CIRCUIT LIFESPAN OF CONTINUOUS KIDNEY REPLACEMENT THERAPY (CKRT)

Abstract

Abstract Background and Aims Approximately half of patients in intensive care unit (ICU) experienced acute kidney injury (AKI). ICU patients with severe AKI and hemodynamic instability sometimes require continuous kidney replacement therapy (CKRT). Termination of CKRT circuits leads to blood loss, attenuation of therapeutic effects of CKRT, and a heavy workload and resource burden for medical staff. Identification of the factors which can prolong the lifespan of CKRT circuits is clinically essential. We aimed to elucidate the factors affecting the lifespan of CKRT circuits in ICU patients. Method We evaluated the lifespans of 559 CKRT circuits used for 63 ICU patients at the Okinawa Prefectural Nanbu Medical Center and Children's Medical Center from April 1st, 2021 to March 31st, 2022. We enrolled all ICU patients who required CKRT. Our research team prospectively collected information on the patients' basal characteristics, CKRT prescription, activated clotting time (ACT) after the hemofilter, CKRT circuit lifespan, and causes of termination of circuits prospectively. Effects of ACT were examined by grouping patients into three with their ACT values: <140, 140≦ and <180, and ≧180 seconds. The primary outcome of this study was a termination of the CKRT circuit within 24 hours after the initiation of the CKRT circuit. The secondary outcome was the cause of terminating CKRT circuits. Primarily, we examined the impacts of factors associated with CKRT circuit lifespan using multivariable Cox-proportional hazards regression. Results Our cohort's median follow-up period of CKRT hemofilter was 18.5 hours. The total number of participants was 63, and 63.5% were male. In the multivariate Cox regression analysis, targeting ACT between 140 to 180 seconds was associated with a longer circuit lifespan (HR = 2.11(1.43-3.11), p<0.0001) than the group of CKRT circuits with ACT<140 seconds. Based on our results, targeting ACT between 140 to 180 seconds extended the median survival time of the circuit lifespan to 1.4 times longer than the group of circuits with ACT less than 140 (Fig. 1). There were no differences in the causes of hemofilter occlusion among the three ACT groups. Notably, COVID-19 was not significantly associated with a reduction in circuit lifespans (HR = 0.63(0.35-1.11), p = 0.110). Conclusion Appropriate monitoring of ACT during CKRT may help prolong circuit lifespan, and the optimal ACT range was 140 to 180 seconds. In contrast, COVID-19 was not a risk factor for an early occlusion of CKRT circuits.