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Abstract
Background Continuous renal replacement therapy (CRRT) is an essential procedure for patients with acute kidney injury in intensive care. It is important to maintain an adequate blood flow rate during CRRT. Several previous studies have reported the relationships between blood flow rate and filter lifespan, or circuit life, in CRRT. Here, we aim at elucidating the incidence and factors associated with a decreased blood flow rate in CRRT. Methods This is a retrospective observational study. From January 2014 to June 2017, 119 patients who underwent CRRT in the intensive care unit were enrolled. The definition of a decreased blood flow rate included situations in which the medical staff needed to decrease the blood flow volume. We statistically analyzed the association of the decreased blood flow rate with patients' clinical characteristics. Results Of 119 patients, 52 required a decreased blood flow rate during CRRT. Almost half of the cases occurred within one day of starting CRRT. None of the clinical factors (age, sex, height, sequential organ failure assessment (SOFA) score, catheter position, systemic infection, albumin, hemoglobin, and activating coagulation time) were significantly associated with decreased blood flow rate. Conclusions A decreased blood flow rate often occurs during CRRT. Clinical factors significantly associated with the occurrence of the decreased blood flow rate were not detected in the current study. Further investigation regarding the occurrence of a decreased blood flow is warranted.
Highlights
In intensive care units, the frequency of acute kidney injury is approximately 30–40% [1], and continuous renal replacement therapy (CRRT) is often required [2]
Nafamostat mesylate was administered from the Continuous renal replacement therapy (CRRT) machine before blood entered the hemofilter. e vascular access catheter used in the current study was uniform for all patients. e clinical physician who inserted the vascular access catheter decided whether to double or triple the lumen catheter. e urokinase-coated temporary vascular access catheter (Blood Access UK-Catheter kit, NIPRO, Tokyo, Japan) was used universally in all patients. e size of the catheters was 11.5 Fr. e CRRT machines used in this study were the JUN-505 (Junken Medical, Tokyo, Japan), JUN55X (Junken Medical, Tokyo, Japan), or AcuFil Multi 55X-II (Japan Lifeline, Tokyo, Japan). ese machines perform CRRT in a similar manner and require the same blood circuits
continuous venovenous hemodiafiltration (CVVHDF) was performed by the postdilution method in all cases (Tables 1 and 2). e primary dose of quantity of filtration (Qf ), quantity of dialysis fluid (Qd), and quantity of ultrafiltration (Quf ) for CVVHDF and continuous venovenous hemodialysis (CVVHD) was recorded
Summary
The frequency of acute kidney injury is approximately 30–40% [1], and continuous renal replacement therapy (CRRT) is often required [2]. Decreased blood flow rate from the vascular access catheter includes the several complications, such as decreased CRRT efficiency, increase of therapy downtime, potential loss of solute, acid-base and fluid balance control, increased therapy cost, and a reduction in circuit or filter life, resulting in patients’ blood loss. Baldwin et al investigated the relationship between the decrease in the blood flow rate and circuit life in CRRT [8]. Frequent reductions in blood flow rates were significantly associated with a decreased circuit life [8]. Continuous renal replacement therapy (CRRT) is an essential procedure for patients with acute kidney injury in intensive care. Further investigation regarding the occurrence of a decreased blood flow is warranted
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