Abstract: SA-PO1094
Premature CRRT Circuit Failure Across Multiple Intensive Care Units (ICUs): A Baseline Quality Improvement Assessment
Session Information
- Kidney Replacement Therapy and Care Delivery Innovations
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Rafaey, Wania, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
- Khaliq, Muhammad, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
- Ramrattan, Amit, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
- Hussein, Wael F., The University of Tennessee Health Science Center, Memphis, Tennessee, United States
Background
Premature CRRT circuit loss results in interruptions in therapy, blood loss, increased nursing workload, and higher cost. Regional citrate anticoagulation has been associated with improved circuit longevity and is recommended in many CRRT protocols. We performed a baseline evaluation of CRRT circuit performance and anticoagulation practices across local ICUs prior to planned protocol optimization and training interventions.
Methods
We conducted a retrospective baseline QI assessment in four ICUs within two hospitals during the last 6 months of 2025. Data were collected by nephrology fellows using a standardized REDCap tool. Anticoagulation strategy, circuit run duration (circuit life), and reasons for discontinuation or interruptions were recorded. Circuit failure was defined as discontinuation due to filter clotting. The primary outcome was clotting-free circuit survival, censored for other reasons of discontinuation. Kaplan-Meier methods were used to estimate clotting-free survival and Cox proportional hazards analysis to compare clotting risk between anticoagulation strategies.
Results
During the study period, 345 CRRT circuits were analyzed from 69 patients, with a median of 3 (IQR 2 - 6) circuits per patient. Circuits lasted for a median of 17 (8 – 32) hours. Anticoagulation strategy was heparin in 237 (69%) circuits and citrate in 4 (1%), while 102 (30%) circuits were run with no anticoagulation. Clotting-free circuit survival at 24, 48, and 72 hours was 65% (95% CI: 59%-71%), 48% (41% - 57%), and 39% (30% - 50%) respectively. Circuits with no anticoagulation demonstrated a higher risk of clotting compared to heparin-anticoagulated circuits (HR 1.39, 95% CI: 0.95 – 2.03). Anticoagulation practices and circuit outcomes were generally similar across participating ICU sites.
Conclusion
Baseline QI assessment demonstrated frequent premature CRRT circuit loss, a high proportion of circuits with no anticoagulation, and minimal use of regional citrate anticoagulation. Circuit longevity appeared below published benchmark ranges. These findings support protocol revision, broader citrate anticoagulation utilization, and multidisciplinary training initiatives to improve circuit longevity.