Abstract: TH-PO0775
When Adequate Anticoagulation Is Not Enough: Propofol-Induced Hypertriglyceridemia Causing Recurrent CRRT Filter Clotting
Session Information
- AKI: Critical Care, CKRT, Cardiorenal Syndromes, and Clinical Outcomes
October 22, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Author
- Oppegaard, Kylie, University of Michigan, Ann Arbor, Michigan, United States
Introduction
Propofol-induced hypertriglyceridemia is a rare complication in critically ill patients, with potential consequences including pancreatitis and extracorporeal circuit dysfunction. Recurrent continuous renal replacement therapy (CRRT) filter clotting is often attributed to inadequate anticoagulation. Alternative etiologies should be considered when clotting persists despite therapeutic anticoagulation. A case of severe propofol-induced hypertriglyceridemia causing recurrent CRRT circuit clotting despite adequate anticoagulation successfully managed with insulin infusion is presented.
Case Description
A 63-year-old female with metabolic dysfunction–associated steatotic liver disease cirrhosis presented with melena and confusion developed hematemesis and aspiration pneumonitis that required intubation and sedatation with propofol at 30 mcg/kg/min, and vasopressor support. Hopsital course was further complicated by oliguric acute kidney injury with refractory volume overload, prompting CRRT initiation with regional citrate anticoagulation. She experienced progressively elevated return pressures to 297 mmHg and recurrent circuit clotting despite therapeutic circuit ionized calcium at 0.33 mmol/L. On day three, the appearance of lipemic discoloration within the circuit prompted triglyceride measurement, revealing a level of 970 mg/dL. Propofol was discontinued and an insulin infusion was initiated with normalization of circuit pressures and resolution of recurrent clotting.
Discussion
Propofol-induced hypertriglyceridemia is an underrecognized cause of recurrent CRRT filter clotting despite adequate anticoagulation. Early targeted management with propofol discontinuation and insulin infusion may restore circuit function and improve CRRT delivery in critically ill patients.