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Abstract: PO1190

Skim the Fat: PLEX for Hypertriglyceridemia-Induced CRRT Clotting

Session Information

Category: Trainee Case Report

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Schulman, Ruth, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
  • Kruger gomes, Larissa, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
  • Agarwal, Krishna A., Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
  • Sula Karreci, Esilida, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
  • Freed, Jason A., Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
  • Hoenig, Melanie P., Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
Introduction

CRRT filter clotting remains a significant barrier to providing adequate dialysis in critically ill patients. Clotting leads to reduced clearance and volume removal, blood loss in the circuit, and increased nursing workload. Elevated triglycerides have been reported to result in filter clotting. Here, we present a case of CRRT circuit clotting in a patient with familial hypertriglyceridemia-induced pancreatitis.

Case Description

A 46-year-old man with obesity, hyperlipidemia, recurrent pancreatitis secondary to hypertriglyceridemia, and DMII presents with 2 days of abdominal pain. CT abdomen showed pancreatic necrosis and stranding prompting admission for pancreatitis. Hospital course was complicated by hypoxic respiratory failure requiring intubation, shock, and oliguric AKI requiring initiation of CVVHDF. Shortly after initiation of CVVHDF, the filter and tubing clotted with a milky yellow substance. This recurred after circuit exchange and use of regional anticoagulation with Citrate Dextrose 3%. Triglyceride level returned at 3,668 mg/dL (reference range: <150 mg/dL). Given the severe hypertriglyceridemia and inability to effectively provide RRT, he underwent one session of therapeutic plasma exchange (PLEX) with subsequent fall in triglyceride levels to 433 mg/dL. Further CRRT was then effectively provided with typical filter and circuit life.

Discussion

This case highlights the impact of elevated triglyceride levels on CRRT filter life. Prior case reports have described clotting and shortened filter life in the setting of lipid infusion and propofol-induced hypertriglyceridemia despite regional Citrate anticoagulation. Triglyceride levels fell and clotting resolved with cessation of the infusions in both situations. In the setting of a non-iatrogenic etiology of elevated triglycerides, we suggest consideration of anticipatory plasma exchange to avoid CRRT filter clotting and to be able to provide more effective dialysis.

Milky Substance Noted Throughout CRRT Circuit and PLEX Effluent