POS-621 FACTORS AFFECTING HEMOFILTER LIFESPAN IN CRITICALLY ILL ADULTS RECEIVING CONTINUOUS KIDNEY REPLACEMENT THERAPY : A SINGLE CENTRE EXPERIENCE

ABSTRACT

Introduction: Continuous kidney replacement therapy (CKRT) offers more hemodynamic stability by permitting gradual removal of solute and fluid in critically ill adults. However the success of each CKRT session depends much on the hemofilter lifespan. Thus optimising hemofilter lifespan and performance efficiency in CKRT has been a focus in many studies over the years. The objective of this study is to look at the factors affecting hemofilter lifespan in critically ill adults with CKRT in our centre. Methods: A prospective observational study was conducted from 1st to 31stAugust 2021 in Intensive Care Unit (ICU), Hospital Selayang, Malaysia. Every CKRT sessions prescribed to critically ill adults (18 years and above) during the study period were included. Demographics of patient, biochemical results, CKRT prescriptions and lifespan of the hemofilter for each session were recorded. Results: Total of 46 patients were recruited with 51 sessions of CKRT performed. Male patients were 70.6%.Mean age was 44 ± 11 years. Almost half of the patients (49%) have underlying hypertension and 41% has diabetes. Majority were Covid-19 patients (92.2% ).Sepsis due to Covid-19 (82.4%) was main cause of ICU admission followed by other medical admission such as cardiogenic shock without Covid-19 (11.8%), surgical admission with Covid-19 (3.8%) and surgical admission without Covid-19 (2%). Indications for dialysis were refractory metabolic acidosis (56%),refractory hyperkalemia (24%) and fluid overload (20%). CKRT was performed due to severe shock (91.3%) and raised intracranial pressure (8.7%). Single inotrope was used in 84.3% of CKRT sessions and remaining had 2 or more inotropes (18%). Mean systolic blood pressure was 122 ± 16 mmHg. Anticoagulation used were heparin (70.6 %) and citrate ( 5.9%).No anticoagulation in remaining 23.5% sessions. Mean hemofilter lifespan was 30± 23 hours however death censored mean hemofilter lifespan was 40±22 hours. Hemofilter lasted less than 24 hours (mean 10± 4 hours) in 51% sessions, ≥ 24 hours but < 48 hours (mean 36± 7 hours) 25.4%, ≥48 hours but < 72 hours (mean 59±10 hours) 11.8% and 72 hours in 11.8% sessions (p= 0.005). The hemofilter lasted ≥24 hours when anticoagulant (heparin or citrate) is used compared to without anticoagulant (36±23 hours versus 9±3 hours;P = 0.005). Mean hemofilter lifespan among Covid-19 patients were longer compared to non Covid -19 patients ( 30±24 hours vs 24±18 hours, P=0.937).This maybe due to anticoagulant used in this group of patient as part of Covid-19 management. No significant differences in hemofilter life were found according to age, gender, comorbidity, diagnoses, hemofilter type, site of venous access, blood flow rate, filtration fraction,type of anticoagulant, inotropic drug support, haemoglobin,D Dimer,INR and platelet. Conclusions: Anticoagulants increase the hemofilter lifespan up to 40 hours in critically ill adults receiving continuous kidney replacement therapy. No conflict of interest