Abstract: PO0694
CRRT Circuit Patency in Patients with COVID-19 and AKI
Session Information
- COVID-19: AKI and Outcomes
October 22, 2020 | Location: On-Demand
Abstract Time: 10:00 AM - 12:00 PM
Category: Coronavirus (COVID-19)
- 000 Coronavirus (COVID-19)
Authors
- Shaikhouni, Salma, University of Michigan, Ann Arbor, Michigan, United States
- Sohaney, Ryann, University of Michigan, Ann Arbor, Michigan, United States
- Ludwig, John Travis, University of Michigan, Ann Arbor, Michigan, United States
- Tilea, Anca, University of Michigan, Ann Arbor, Michigan, United States
- Bitzer, Markus, University of Michigan, Ann Arbor, Michigan, United States
- Yessayan, Lenar Tatios, University of Michigan, Ann Arbor, Michigan, United States
- Heung, Michael, University of Michigan, Ann Arbor, Michigan, United States
Background
COVID-19 is associated with AKI and hypercoagulable state, which may present challenges in delivering CRRT. We present our center’s experience with CVVHDF with regional citrate anticoagulation (RCA) in COVID-19, with special attention to circuit life.
Methods
We performed a retrospective review of 32 consecutive patients with COVID-19 and AKI managed with CVVHDF-RCA at the University of Michigan. CVVHDF was prescribed according to institutional protocol consisting of a fixed blood flow to citrate ratio with target post-filter ionized calcium 0.2-0.4mmol/L. Replacement fluid was delivered post-filter. Primary outcome was mean circuit life per patient during the first 7 days of CRRT. We used Wilcoxon rank sum to examine whether systemic anticoagulation use associated with circuit life. We used univariate linear regression to assess the relationship between baseline inflammatory markers and circuit life.
Results
Prior to CRRT start, the median ferritin was 1587 (IQR 933-2219) ng/ml, d-dimer 6.0 (IQR 3.0-9.5) mg/ml and CRP 20.0 (IQR 8.6-33.0) mg/dl. The mean patient circuit life was 56.9 (SD 28.8) hours. Mean circuit life was 54.3 (SD 23.1) hours for those on systemic anticoagulation (n=23) and 63.6 (SD 29.1) hours for those without (n=9), p=0.39. There was no association between circuit life and inflammatory makers (ferritin p=0.92, CRP p=0.29, d-dimer p=0.24).
Conclusion
The circuit life in COVID-19 patients on CVVHDF-RCA at our institution was similar to our experience with non-COVID-19 patients, and longer than what has been reported in randomized controlled trials assessing anticoagulation protocols in CRRT. We found no association between systemic anticoagulation use or inflammatory markers and circuit life, further supporting that a standardized CVVHDF-RCA protocol with fixed blood flow to citrate rate provides an effective means of maintaining CRRT circuit patency in patients with COVID-19 infection at increased risk of clotting.
Funding
- NIDDK Support