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REVIEW article

Front. Med.
Sec. Intensive Care Medicine and Anesthesiology
Volume 11 - 2024 | doi: 10.3389/fmed.2024.1442065

How to Safeguard the Continuous Renal Replacement Therapy Circuit: A Narrative Review

Provisionally accepted
Chaomin Hu Chaomin Hu 1,2*Pengfei Shui Pengfei Shui 2*Bo Zhang Bo Zhang 2*Xin Xu Xin Xu 1*Zhengquan Wang Zhengquan Wang 3*Bin Wang Bin Wang 4*Jie Yang Jie Yang 2*Xiang Yang Xiang Yang 1Jun Zhang Jun Zhang 3*Hongying Ni Hongying Ni 5*Yucai Hong Yucai Hong 2*Zhongheng Zhang Zhongheng Zhang 2*
  • 1 Department of Emergency Medicine, Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, China
  • 2 Department of Emergency Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
  • 3 Department of Emergency Medicine, Yuyao City People's Hospital, Yuyao, Zhejiang, China
  • 4 Department of Emergency Medicine, People's Hospital of Anji, Anji, China
  • 5 Department of Critical Care Medicine, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China

The final, formatted version of the article will be published soon.

    The high prevalence of Acute Kidney Injury (AKI) in ICU patients emphasizes the need to understand factors influencing Continuous Renal Replacement Therapy (CRRT) circuit lifespan for optimal outcomes. This review examines key pharmacological interventions — citrate (especially in regional citrate anticoagulation), unfractionated heparin (UFH), low molecular weight heparin (LMWH), and nafamostat mesylate (NM) — and their effects on filter longevity. Citrate shows efficacy with lower bleeding risks, while UFH remains cost-effective, particularly in COVID-19 cases. LMWH is effective but associated with higher bleeding risks. NM is promising for high-bleeding risk scenarios. The review advocates for non-tunneled, non-cuffed temporary catheters, especially bedside-inserted ones, and discusses advantages of surface-modified dual-lumen catheters. Material composition, such as polysulfone membranes, impacts filter lifespan. Treatment modality choice (CVVHD or CVVHDF), effluent volume, blood flow rates, and downtime management are critical in prolonging filter longevity in CRRT. Patient-specific conditions and early mobilization during CRRT contribute to extending filter lifespan. In conclusion, this review offers insights into factors influencing CRRT circuit longevity, supporting evidence-based practices and suggesting further multicenter studies to guide ICU clinical decisions.

    Keywords: Continuous renal replacement therapy1, acute kidney injury2, filter lifespan3, pharmacological interventions4, non-pharmacological factors5

    Received: 01 Jun 2024; Accepted: 30 Jul 2024.

    Copyright: © 2024 Hu, Shui, Zhang, Xu, Wang, Wang, Yang, Yang, Zhang, Ni, Hong and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence:
    Chaomin Hu, Department of Emergency Medicine, Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, China
    Pengfei Shui, Department of Emergency Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
    Bo Zhang, Department of Emergency Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
    Xin Xu, Department of Emergency Medicine, Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, China
    Zhengquan Wang, Department of Emergency Medicine, Yuyao City People's Hospital, Yuyao, Zhejiang, China
    Bin Wang, Department of Emergency Medicine, People's Hospital of Anji, Anji, China
    Jie Yang, Department of Emergency Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
    Jun Zhang, Department of Emergency Medicine, Yuyao City People's Hospital, Yuyao, Zhejiang, China
    Hongying Ni, Department of Critical Care Medicine, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
    Yucai Hong, Department of Emergency Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
    Zhongheng Zhang, Department of Emergency Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.