Filter clotting with continuous renal replacement therapy in COVID-19
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Filter clotting with continuous renal replacement therapy in COVID-19 Paul Endres1 · Rachel Rosovsky2 · Sophia Zhao1 · Scott Krinsky1 · Shananssa Percy1 · Omer Kamal3 · Russel J. Roberts4 · Natasha Lopez4 · Meghan E. Sise1 · David J. R. Steele1 · Andrew L. Lundquist1 · Eugene P. Rhee1 · Kathryn A. Hibbert5 · C. Corey Hardin5 · Finnian R. Mc Causland3 · Peter G. Czarnecki3 · Walter Mutter6 · Nina Tolkoff‑Rubin1 · Andrew S. Allegretti1 Accepted: 28 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Coronavirus disease 2019 (COVID-19) appears to be associated with increased arterial and venous thromboembolic disease. These presumed abnormalities in hemostasis have been associated with filter clotting during continuous renal replacement therapy (CRRT). We aimed to characterize the burden of CRRT filter clotting in COVID-19 infection and to describe a CRRT anticoagulation protocol that used anti-factor Xa levels for systemic heparin dosing. Multi-center study of consecutive patients with COVID-19 receiving CRRT. Primary outcome was CRRT filter loss. Sixty-five patients were analyzed, including 17 using an anti-factor Xa protocol to guide systemic heparin dosing. Fifty-four out of 65 patients (83%) lost at least one filter. Median first filter survival time was 6.5 [2.5, 33.5] h. There was no difference in first or second filter loss between the anti-Xa protocol and standard of care anticoagulation groups, however fewer patients lost their third filter in the protocolized group (55% vs. 93%) resulting in a longer median third filter survival time (24 [15.1, 54.2] vs. 17.3 [9.5, 35.1] h, p = 0.04). The rate of CRRT filter loss is high in COVID-19 infection. An anticoagulation protocol using systemic unfractionated heparin, dosed by anti-factor Xa levels is reasonable approach to anticoagulation in this population. Keywords Continuous venovenous hemofiltration · CRRT · CVVH · Acute kidney injury · End stage renal disease · Hemodialysis · Hemofiltration · Coronavirus · SARS · SARS-CoV2 · Hypercoagulability · Thrombosis
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11239-020-02301-6) contains supplementary material, which is available to authorized users. * Andrew S. Allegretti [email protected]
Abbreviations COVID-19 Coronavirus disease 2019 CRRT Continuous renal replacement therapy UFH Unfractionated heparin ICU Intensive care unit AKI Acute kidney injury CVVH Continuous venovenous hemofiltration
Division of Nephrology, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, GRB 1008, Boston, MA 02114, USA
Highlights
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Division of Hematology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
• We reviewed our first 65 patients who received
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Division of Renal Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
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Department of Pharmacy, Massachusetts General Hospital, Boston, MA, USA
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Division of Pulmonary and Critical Care,
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