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Abstract
Background Filter clotting is frequent during continuous renal replacement therapy (CRRT), which increases anemia risk. We studied anemia and blood transfusion in critically ill patients requiring CRRT for acute kidney injury and assessed the relationship between CRRT filter life span and PRBC transfusion. Methods A case-control study was conducted at a tertiary-care intensive care unit (ICU) where CRRT cases were matched with controls for age, gender, admission category, and severity of illness. Daily hemoglobin levels, blood transfusions, and life span of CRRT filter were noted. CCRT patients were categorized according to the median of the filter life span (20 hours). Results Ninety-five cases and 102 controls were enrolled. The hemoglobin level on admission was similar in the two groups, yet cases had significantly lower hemoglobin levels than controls (72.8 ± 15.3 versus 82.5 ± 20.7 g/L, p < 0.001) during ICU stay. Anemia <70 g/L occurred in 50% of cases and 19% of controls (p < 0.001). Most (56.3%) cases were transfused compared with 29.9% for controls (p < 0.001) with higher number of transfused packed red blood cell (PRBC) units in cases (2.6 ± 4.0 versus 1.5 ± 3.2 units per patient, p=0.03). Patients with shorter versus longer filter life had similar hemoglobin level in the first 7 days of CRRT with no difference in PRBC transfusion requirement. Prefilter heparin use and hemodialysis access location were not associated with longer filter life span. The mortality was similar in patients with shorter versus longer filter life. Conclusions CRRT in ICU was associated with larger drop in hemoglobin and more PRBC transfusion. Shorter (<20 hours) versus longer CCRT filter life was not associated with increased PRBC transfusion.
Highlights
Acute kidney injury (AKI) is common in critically ill patients and may develop in about two thirds of the patients admitted to the intensive care unit (ICU) [1]
Before obtaining the cases and controls, we excluded patients staying less than 7 days in the ICU, who had hemoglobin level of
A total of 197 patients were enrolled; 95 patients who had CRRT in the ICU and 102 controls. e demographic and baseline clinical data of the study participants are summarized in Table 1. ere were no significant differences between the two groups in the variables used for matching cases and controls
Summary
Acute kidney injury (AKI) is common in critically ill patients and may develop in about two thirds of the patients admitted to the intensive care unit (ICU) [1]. Blood loss can cause anemia and may increase the requirement for blood transfusion. Clinical studies have shown an association between CRRT and anemia and blood transfusion. We studied anemia and blood transfusion in critically ill patients requiring CRRTfor acute kidney injury and assessed the relationship between CRRT filter life span and PRBC transfusion. Blood transfusions, and life span of CRRT filter were noted. Patients with shorter versus longer filter life had similar hemoglobin level in the first 7 days of CRRT with no difference in PRBC transfusion requirement. E mortality was similar in patients with shorter versus longer filter life. Shorter (
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