Effect of different filtration fraction calculation formulas on extracorporeal circulation life of continuous renal replacement therapy_West China Medical Journal

Authors：

LI Mingpeng ^1,2 , ZHANG Ling ¹ , YANG Yingying ¹ , TANG Xue ¹ , WANG Fang ¹ , LI Xu ¹ ,  CHEN Dezheng ²

1. Department of Nephrology and Institute of Kidney Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Department of Nephrology, Jianyang People’s Hospital, Jianyang, Sichuan 641400, P. R. China;

Corresponding author：

CHEN Dezheng, Email: 670054896@qq.com

Keywords：

Acute kidney injury; regional citrate anticoagulation; continuous renal replacement therapy; filtration fraction; extracorporeal circulation life

DOI：

10.7507/1002-0179.202306164

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To evaluate the effects of two filtration fraction formulas on extracorporeal circulation life of continuous renal replacement therapy (CRRT) under regional citrate anticoagulation. Methods Patients with acute kidney injury who received CRRT treatment with regional citrate anticoagulation and the estimated CRRT duration was greater than 24 h at West China Hospital of Sichuan University between June 2022 and April 2023 were selected. They were randomly divided into continuous veno-venous hemofiltration (CVVH), continuous veno-venous hemodialysis (CVVHD) and continuous veno-venous hemodiafiltration (CVVHDF) groups using Prismaflex machines. The life of the CRRT extracorporeal circulation in the three groups of patients was compared, and the reasons for replacing the extracorporeal circulation after 72 h were not used, and the filtration fraction score of the three groups was calculated according to the two filtration score calculation formulas (Formula 1 and Formula 2) currently used in the world. The filtration value obtained by the two filtration fraction calculation formulas was taken as the test variable, and whether the median life of the group with the longest extracorporeal circulation life was taken as the state variable, and the receiver operating characteristic curve was drawn, and the area under the curve was calculated. Results A total of 121 patients were included, including 40 patients in the CVVH group, 40 patients in the CVVHD group, and 41 patients in the CVVHDF group. The extracorporeal circulation life of CVVH group, CVVHD group and CVVHDF group was 64 (46, 71) h, 47 (31.5, 54) h and 70 (65, 72) h, respectively, with statistical difference (log-rank P=0.036). A total of 94 cases were replaced due to filter or venous pot clotting after 72 h after the filter was not used, including 30 cases in the CVVH group, 39 cases in the CVVHD group, and 25 cases in the CVVHDF group. The difference between the three groups was statistically significant (χ²=15.83, P<0.001). According to Formula 1, the filtration fraction of CVVH group, CVVHD group and CVVHDF group was 15.8% (15.2%, 17.0%), 1.1% (0.7%, 2.1%) and 16.2% (14.9%, 17.6%), respectively, and the difference among the three groups was statistically significant (H=69.402, P<0.001). According to Formula 2, the filtration fraction of CVVH group, CVVHD group and CVVHDF group was 33.1% (32.4%, 35.7%), 4.0% (3.6%, 4.9%) and 19.1% (17.7%, 20.7%), respectively, and the differences among the three groups and pairwise comparison between groups were statistically significant (P<0.001). The area under the receiver operating characteristic curvec calculated by the Formula 1 and 2 for the influence of filtration fraction on extracorporeal circulation life were 0.539 and 0.668, the sensitivity were 43.18% and 82.22%, and the specificity were 80.65% and 56.25%, respectively. Conclusions When using Prismaflex machine, the filter life of CVVHD is shorter than CVVH and CVVHDF modes. The filtration fraction calculated by Formula 2 is more sensitive but less specific in predicting CRRT extracorporeal circulation life. Filtration fraction as a CRRT extracorporeal circulation risk assessment has limitations, especially for the CVVH model with pre and post replacement.

Citation： LI Mingpeng, ZHANG Ling, YANG Yingying, TANG Xue, WANG Fang, LI Xu, CHEN Dezheng. Effect of different filtration fraction calculation formulas on extracorporeal circulation life of continuous renal replacement therapy. West China Medical Journal, 2024, 39(7): 1088-1095. doi: 10.7507/1002-0179.202306164 Copy

1.	Canaud B, Cohen EP. Initiation of renal-replacement therapy in the intensive care unit. N Engl J Med, 2016, 375(19): 1901.
2.	Kellum JA, Lameire N, Aspelin P, et al. Kidney disease: improving global outcomes (KDIGO) acute kidney injury work group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl, 2012, 2(1): 1-138.
3.	Joannidis M, Oudemans-van Straaten HM. Clinical review: patency of the circuit in continuous renal replacement therapy. Crit Care, 2007, 11(4): 218.
4.	中华医学会肾脏病学分会专家组. 连续性肾脏替代治疗的抗凝管理指南. 中华肾脏病杂志, 2022, 38(11): 1016-1024.
5.	MacEwen C, Watkinson P, Winearls C. Circuit life versus bleeding risk: the impact of achieved activated partial thromboplastin time versus achieved filtration fraction. Ther Apher Dial, 2015, 19(3): 259-266.
6.	Hatamizadeh P, Tolwani A, Palevsky P. Revisiting filtration fraction as an index of the risk of hemofilter clotting in continuous venovenous hemofiltration. Clin J Am Soc Nephro, 2020, 15(11): 1660-1662.
7.	RENAL Replacement Therapy Study Investigators; Bellomo R, Cass A, et al. Intensity of continuous renal replacement therapy in critically ill patients. N Engl J Med, 2009, 361(17): 1627-1638.
8.	Zhang L, Liao Y, Xiang J, et al. Simplified regional citrate anticoagulation using a calcium-containing replacement solution for continuous venovenous hemofiltration. J Artif Organs, 2013, 16(2): 185-192.
9.	Arnold F, Westermann L, Rieg S, et al. Comparison of different anticoagulation strategies for renal replacement therapy in critically ill patients with COVID-19: a cohort study. BMC Nephrol, 2020, 21(1): 486.
10.	Huguet M, Rodas L, Blasco M, et al. Clinical impact of regional citrate anticoagulation in continuous renal replacement therapy in critically ill patients. Int J Artif Organs, 2017, 40(12): 676-682.
11.	Zarbock A, Küllmar M, Kindgen-Milles D, 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. JAMA, 2020, 324(16): 1629-1639.
12.	Ricci Z, Ronco C, Bachetoni A, et al. Solute removal during continuous renal replacement therapy in critically ill patients: convection versus diffusion. Crit Care, 2006, 10(2): R67.
13.	Brain M, Winson E, Roodenburg O, et al. Non anti-coagulant factors associated with filter life in continuous renal replacement therapy (CRRT): a systematic review and meta-analysis. BMC Nephrol, 2017, 18(1): 69.
14.	Kleger GR, Fässler E. Can circuit lifetime be a quality indicator in continuous renal replacement therapy in the critically ill?. Int J Artif Organs, 2010, 33(3): 139-146.
15.	Kellum JA, Ronco C. The 17th acute disease quality initiative international consensus conference: introducing precision renal replacement therapy. Blood Purif, 2016, 42(3): 221-223.
16.	Neri M, Villa G, Garzotto F, et al. Nomenclature for renal replacement therapy in acute kidney injury: basic principles. Crit Care, 2016, 20(1): 318.
17.	Uchino S, Fealy N, Baldwin I, et al. Pre-dilution vs. post-dilution during continuous veno-venous hemofifiltration: impact on fifilter life and azotemic control. Nephron Clin Pract, 2003, 94(4): c94-c98.
18.	van der Voort PH, Gerritsen RT, Kuiper MA, et al. Filter run time in CVVH: pre- versus post-dilution and nadroparin versus regional heparin-protamine anticoagulation. Blood Purif, 2005, 23(3): 175-180.
19.	Tolwani A. Continuous renal-replacement therapy for acute kidney injury. N Engl J Med, 2012, 367(26): 2505-2514.
20.	Sansom B, Sriram S, Presneill J, et al. Low blood flow continuous veno-venous haemodialysis compared with higher blood flow continuous veno-venous haemodiafiltration: effect on alarm rates, filter life, and azotaemic control. Blood Purif, 2022, 51(2): 130-137.
21.	Cassina T, Villa M, Soldani-Agnello A, et al. Comparison of two regional citrate anticoagulation modalities for continuous renal replacement therapy by a prospective analysis of safety, workload, effectiveness, and cost. Minerva Anestesiol, 2021, 87(12): 1309-1319.
22.	Xu Q, Jiang B, Li J, et al. Comparison of filter life span and solute removal during continuous renal replacement therapy: convection versus diffusion- a randomized controlled trial. Ther Apher Dial, 2022, 26(5): 1030-1039.

1. Canaud B, Cohen EP. Initiation of renal-replacement therapy in the intensive care unit. N Engl J Med, 2016, 375(19): 1901.
2. Kellum JA, Lameire N, Aspelin P, et al. Kidney disease: improving global outcomes (KDIGO) acute kidney injury work group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl, 2012, 2(1): 1-138.
3. Joannidis M, Oudemans-van Straaten HM. Clinical review: patency of the circuit in continuous renal replacement therapy. Crit Care, 2007, 11(4): 218.
4. 中华医学会肾脏病学分会专家组. 连续性肾脏替代治疗的抗凝管理指南. 中华肾脏病杂志, 2022, 38(11): 1016-1024.
5. MacEwen C, Watkinson P, Winearls C. Circuit life versus bleeding risk: the impact of achieved activated partial thromboplastin time versus achieved filtration fraction. Ther Apher Dial, 2015, 19(3): 259-266.
6. Hatamizadeh P, Tolwani A, Palevsky P. Revisiting filtration fraction as an index of the risk of hemofilter clotting in continuous venovenous hemofiltration. Clin J Am Soc Nephro, 2020, 15(11): 1660-1662.
7. RENAL Replacement Therapy Study Investigators; Bellomo R, Cass A, et al. Intensity of continuous renal replacement therapy in critically ill patients. N Engl J Med, 2009, 361(17): 1627-1638.
8. Zhang L, Liao Y, Xiang J, et al. Simplified regional citrate anticoagulation using a calcium-containing replacement solution for continuous venovenous hemofiltration. J Artif Organs, 2013, 16(2): 185-192.
9. Arnold F, Westermann L, Rieg S, et al. Comparison of different anticoagulation strategies for renal replacement therapy in critically ill patients with COVID-19: a cohort study. BMC Nephrol, 2020, 21(1): 486.
10. Huguet M, Rodas L, Blasco M, et al. Clinical impact of regional citrate anticoagulation in continuous renal replacement therapy in critically ill patients. Int J Artif Organs, 2017, 40(12): 676-682.
11. Zarbock A, Küllmar M, Kindgen-Milles D, 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. JAMA, 2020, 324(16): 1629-1639.
12. Ricci Z, Ronco C, Bachetoni A, et al. Solute removal during continuous renal replacement therapy in critically ill patients: convection versus diffusion. Crit Care, 2006, 10(2): R67.
13. Brain M, Winson E, Roodenburg O, et al. Non anti-coagulant factors associated with filter life in continuous renal replacement therapy (CRRT): a systematic review and meta-analysis. BMC Nephrol, 2017, 18(1): 69.
14. Kleger GR, Fässler E. Can circuit lifetime be a quality indicator in continuous renal replacement therapy in the critically ill?. Int J Artif Organs, 2010, 33(3): 139-146.
15. Kellum JA, Ronco C. The 17th acute disease quality initiative international consensus conference: introducing precision renal replacement therapy. Blood Purif, 2016, 42(3): 221-223.
16. Neri M, Villa G, Garzotto F, et al. Nomenclature for renal replacement therapy in acute kidney injury: basic principles. Crit Care, 2016, 20(1): 318.
17. Uchino S, Fealy N, Baldwin I, et al. Pre-dilution vs. post-dilution during continuous veno-venous hemofifiltration: impact on fifilter life and azotemic control. Nephron Clin Pract, 2003, 94(4): c94-c98.
18. van der Voort PH, Gerritsen RT, Kuiper MA, et al. Filter run time in CVVH: pre- versus post-dilution and nadroparin versus regional heparin-protamine anticoagulation. Blood Purif, 2005, 23(3): 175-180.
19. Tolwani A. Continuous renal-replacement therapy for acute kidney injury. N Engl J Med, 2012, 367(26): 2505-2514.
20. Sansom B, Sriram S, Presneill J, et al. Low blood flow continuous veno-venous haemodialysis compared with higher blood flow continuous veno-venous haemodiafiltration: effect on alarm rates, filter life, and azotaemic control. Blood Purif, 2022, 51(2): 130-137.
21. Cassina T, Villa M, Soldani-Agnello A, et al. Comparison of two regional citrate anticoagulation modalities for continuous renal replacement therapy by a prospective analysis of safety, workload, effectiveness, and cost. Minerva Anestesiol, 2021, 87(12): 1309-1319.
22. Xu Q, Jiang B, Li J, et al. Comparison of filter life span and solute removal during continuous renal replacement therapy: convection versus diffusion- a randomized controlled trial. Ther Apher Dial, 2022, 26(5): 1030-1039.

West China Medical Journal

Effect of different filtration fraction calculation formulas on extracorporeal circulation life of continuous renal replacement therapy

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content