Chinese Hepatolgy ›› 2022, Vol. 27 ›› Issue (8): 898-902.

• Other Liver Diseases • Previous Articles     Next Articles

Circuit lifespan during continuous renal replacement therapy in 319 patients with hepatic insufficiency

LIU Hai-xia1, DUAN Zhong-hui2, LAI Mai1, XU Man-man3, MENG Qing-hua4, CHEN Yu3   

  1. 1. Department of Critical Care Medicine of Liver Disease, Beijing You'an Hospital, Capital Medical University, Beijing 100069,China;
    2. Emergency Department, Beijing You'an Hospital, Capital Medical University, Beijing 100069, China;
    3. Department of Medical Oncology, Beijing You'an Hospital, Capital Medical University, Beijing 100069, China;
    4. Department of the Forth Wards of Liver Disease, Beijing You'an Hospital, Capital Medical University, Beijing 100069, China
  • Received:2022-05-08 Online:2022-08-31 Published:2022-09-30

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Abstract: Objective To evaluates the circuit lifespan and complications of CRRT in patients with hepatic insufficiency using different anticoagulation agents.Methods Retrospective analysis of 319 patients with severe liver injury treated with CRRT in the Department of critical medicine of Beijing You'an Hospital in recent 12 years. The effects of systemic heparin, regional citrate anticoagulation (RCA) and non-anticoagulation on circuit lifespan and complications were analyzed. The risk factors affecting circuit lifespan were analyzed.Results The circuit lifespan without anticoagulation was 10 (6,21) hours and was not prolonged by heparin in patients with hepatic insufficiency [13 (9,23), P=0.203]. The circuit lifespan was 21 (11, 56) h anticoagulated with citrate, which was significantly longer than heparin (P=0.000). Bleeding occurred in 30.8% of patients with heparin, while it was 4.2% in RCA. But, the incidence of total calcium / ionized calcium > 2.5 was 25.8% and the incidence of metabolic acidosis and metabolic alkalosis were 16.8 and 12.1% respectively, which were higher than those in the other two groups (P<0.05). Multivariate Cox regression proportional hazards model analysis revealed that liver failure(HR=1.49 ,95%CI:1.16～1.90) and non-citrate anticoagulation(HR=0.51,95%CI:0.43～0.62) were risk factors for circuit life < 48h.Conclusion The circuit lifespan of CRRT in patients with hepatic insufficiency was shortened. Heparin does not provide clinical benefits. RCA can prolong the circuit lifespan but the citrate accumulation must be cautious about. Liver failure and non-RCA were linked to circuit lifespans < 48 hours in patients with liver disease.

Key words: Hepatic insufficiency, Continuous renal replacement treatment, Heparin, Regional citrate anticoagulation, Circuit lifespan