Kidney Week

Abstract: PUB175

Prolonged Intermittent Kidney Replacement Therapy in the Intensive Care Unit: A Single-Center Experience

Session Information

• Publication Only

Category: Dialysis

• 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Chandramohan, Deepak, The University of Alabama at Birmingham, Birmingham, Alabama, United States

Deepak Chandramohan, MD, FASN

• Baker, Calvin Charles Patrick, The University of Alabama at Birmingham, Birmingham, Alabama, United States

Calvin Charles Patrick Baker, MD

• Eggleston, Katrina, DaVita Inc, Denver, Colorado, United States

Katrina Eggleston, CNN, RN

• Neyra, Javier A., The University of Alabama at Birmingham, Birmingham, Alabama, United States

Javier A. Neyra, MD, MS, FASN

• Tolwani, Ashita J., The University of Alabama at Birmingham, Birmingham, Alabama, United States

Ashita J. Tolwani, MD, MS, MSc

• Lu, Yan, The University of Alabama at Birmingham, Birmingham, Alabama, United States

Yan Lu, MD

Background

Prolonged intermittent renal replacement therapy (PIRRT) is a viable RRT option for critically ill hemodynamically unstable patients. Herein, we report a single-center experience of PIRRT delivery to critically ill adults in the ICU.

Methods

This retrospective observational case-series study included non-surgical critically ill adults admitted to the ICU at an acute care hospital affiliated with the University of Alabama at Birmingham. This hospital offers only PIRRT (not CRRT) through the Tablo® Hemodialysis System to ICU patients. We analyzed 38 PIRRT treatments from 15 patients between August 2022 and January 2024. Treatments were administered with a blood flow rate of 150-300 ml/min and a dialysate flow rate of 100 ml/min. No protocol anticoagulation was utilized, but systemic anticoagulation was used if medically indicated. The primary process endpoint was premature filter clotting, defined as clotting of the filter before completion of treatment, and the secondary endpoint was the full treatment completion rate without interruptions.

Results

The median age was 55 years(IQ1-IQ3: 43-79); 46.7% were men, 66.6% Black and 73.3% had AKI. 93.3% were on vasopressors, 66.6% on mechanical ventilation, and 53.3% had septic shock. The median Sequential Organ Failure Assessment (SOFA) score was 12 (10-13), and the median Acute Physiology and Chronic Health Evaluation II (APACHE II) score was 25 (22-29). The dialysis catheter was placed in the internal jugular vein in 66.6% of instances and the femoral vein in 33.3%. The median blood flow rate was 250 ml/min (233.2-250), and the dialysate flow rate was 100ml/min for all treatments. Patients received a median of 2 (1-3) treatments. The median individual treatment duration was 8 hours(6-10). Premature filter clotting occurred in 9 out of 38 treatments (23.6%), and the time to filter clotting was 5.4 hours (3.5-7.6). The treatment completion rate was 94.5% (77-100). The mortality rate was 33.3%; and 40% of patients were transferred to an academic quaternary center for medical and surgical procedures, while 13.3% were transferred to be started on CRRT.

Conclusion

While the provision of PIRRT without protocol anticoagulation to critically ill adults requiring RRT is safe and feasible, about one of four treatments had premature clotting.