Strategies for extending the lifespan of extracorporeal circulation circuit in non-anticoagulated continuous renal replacement therapy_West China Medical Journal

Authors：

LIU Caihong ¹ , BU Qiongxing ² , TANG Xue ³ ,  ZHAO Yuliang ¹

1. Department of Nephrology and Institute of Kidney Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Department of Nephrology, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi 046013, P. R. China;
3. Department of Nephrology, West China Hospital, Sichuan University / West China School of Nursing, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

ZHAO Yuliang, Email: zhaoyuliang@scu.edu.cn

Keywords：

Continuous renal replacement therapy; non-anticoagulated; extracorporeal circulation circuit; coagulation

DOI：

10.7507/1002-0179.202506145

Video：

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Non-anticoagulated continuous renal replacement therapy (CRRT) is usually the main treatment choice for high-risk bleeding patients due to its good safety. The coagulation and shortened lifespan of extracorporeal circulation circuits are the main challenges faced by non-anticoagulated CRRT, and it is particularly important to explore the factors that affect the lifespan of non-anticoagulated CRRT extracorporeal circulation circuits. This article reviews the optimization strategies for extending the lifespan of non-anticoagulated CRRT extracorporeal circulation circuits, including the selection of vascular access and catheter, as well as the setting of CRRT mode, blood flow rate, circuit flush, and replacement fluid dilution methods. The aim is to provide a reference for practitioners in the field of kidney disease and critical care medicine.

Citation： LIU Caihong, BU Qiongxing, TANG Xue, ZHAO Yuliang. Strategies for extending the lifespan of extracorporeal circulation circuit in non-anticoagulated continuous renal replacement therapy. West China Medical Journal, 2025, 40(7): 1157-1161. doi: 10.7507/1002-0179.202506145 Copy

1.	Boldt D, Busse L, Chawla LS, et al. Anticoagulation practices for continuous renal replacement therapy: a survey of physicians from the United States. Ren Fail, 2023, 45(2): 2290932.
2.	Ward DM, Mehta RL. Extracorporeal management of acute renal failure patients at high risk of bleeding. Kidney Int Suppl, 1993, 41: S237-S244.
3.	van de Wetering J, Westendorp RG, van der Hoeven JG, et al. Heparin use in continuous renal replacement procedures: the struggle between filter coagulation and patient hemorrhage. J Am Soc Nephrol, 1996, 7(1): 145-150.
4.	Uchino S, Bellomo R, Morimatsu H, et al. Continuous renal replacement therapy: a worldwide practice survey. The beginning and ending supportive therapy for the kidney (B.E.S.T. kidney) investigators. Intensive Care Med, 2007, 33(9): 1563-1570.
5.	RENAL replacement therapy study investigators, Bellomo R, Cass A, et al. Intensity of continuous renal-replacement therapy in critically ill patients. N Engl J Med, 2009, 361(17): 1627-1638.
6.	Fealy N, Aitken L, du Toit E, et al. Faster blood flow rate does not improve circuit life in continuous renal replacement therapy: a randomized controlled trial. Crit Care Med, 2017, 45(10): e1018-e1025.
7.	Chua HR, Baldwin I, Bailey M, et al. Circuit lifespan during continuous renal replacement therapy for combined liver and kidney failure. J Crit Care, 2012, 27(6): 744.e7-15.
8.	Zhang W, Bai M, Zhang L, et al. Development and external validation of a model for predicting sufficient filter lifespan in anticoagulation-free continuous renal replacement therapy patients. Blood Purif, 2022, 51(8): 668-678.
9.	Ratanarat R, Phairatwet P, Khansompop S, et al. Customized citrate anticoagulation versus no anticoagulant in continuous venovenous hemofiltration in critically ill patients with acute kidney injury: a prospective randomized controlled trial. Blood Purif, 2023, 52(5): 455-463.
10.	Smith SA, Travers RJ, Morrissey JH. How it all starts: initiation of the clotting cascade. Crit Rev Biochem Mol Biol, 2015, 50(4): 326-336.
11.	尹彥玲, 趙聰聰, 胡振杰, 等. 高危出血風險患者無抗凝連續性腎臟替代治療中 AN69 ST 膜對濾器壽命影響的研究. 中華危重病急救醫學, 2015(5): 343-348.
12.	Wong ET, Ong V, Remani D, et al. Filter life and safety of heparin-grafted membrane for continuous renal replacement therapy - a randomized controlled trial. Semin Dial, 2021, 34(4): 300-308.
13.	Naorungroj T, Baldwin I, Eastwood G, et al. The effect of the AN69 ST100 versus oXiris^? membrane on filter life during CRRT for non-anticoagulated liver failure patients. Int J Artif Organs, 2023, 46(4): 209-214.
14.	Crosswell A, Brain MJ, Roodenburg O. Vascular access site influences circuit life in continuous renal replacement therapy. Crit Care Resusc, 2014, 16(2): 127-130.
15.	Brain M, Winson E, Roodenburg O, et al. Non anti-coagulant factors associated with filter life in continuous renal replacement therapy (CRRT): a systematic review and meta-analysis. BMC Nephrol, 2017, 18(1): 69.
16.	Hackbarth R, Bunchman TE, Chua AN, et al. The effect of vascular access location and size on circuit survival in pediatric continuous renal replacement therapy: a report from the PPCRRT registry. Int J Artif Organs, 2007, 30(12): 1116-1121.
17.	Smith T, Kaufman C, Quencer K. Internal jugular central venous catheter tip migration: patient and procedural factors. Tomography, 2022, 8(2): 1033-1040.
18.	Girardot T, Monard C, Rimmelé T. Dialysis catheters in the ICU: selection, insertion and maintenance. Curr Opin Crit Care, 2018, 24(6): 469-475.
19.	Raina R, Sethi S, Khooblall A, et al. Non-anticoagulation pediatric continuous renal replacement therapy methods to increase circuit life. Hemodial Int, 2022, 26(2): 147-159.
20.	Fealy N, Kim I, Baldwin I, et al. A comparison of the Niagara and Medcomp catheters for continuous renal replacement therapy. Ren Fail, 2013, 35(3): 308-313.
21.	Kim I, Fealy N, Baldwin I, et al. A comparison of the Niagara^? and Dolphin^? catheters for continuous renal replacement therapy. Int J Artif Organs, 2011, 34(11): 1061-1066.
22.	Meier P, Meier R, Turini P, et al. Prolonged catheter survival in patients with acute kidney injury on continuous renal replacement therapy using a less thrombogenic micropatterned polymer modification. Nephrol Dial Transplant, 2011, 26(2): 628-635.
23.	Zhou Z, Liu C, Li P, et al. A randomized controlled trial of catheters with different tips and lengths for patients requiring continuous renal replacement therapy in intensive care unit. Crit Care, 2025, 29(1): 148.
24.	Joannidis M, Oudemans-van Straaten HM. Clinical review: patency of the circuit in continuous renal replacement therapy. Crit Care, 2007, 11(4): 218.
25.	Davies HT, Leslie G, Pereira SM, et al. A randomized comparative crossover study to assess the affect on circuit life of varying pre-dilution volume associated with CVVH and CVVHDF. Int J Artif Organs, 2008, 31(3): 221-227.
26.	Ricci Z, Ronco C, Bachetoni A, et al. Solute removal during continuous renal replacement therapy in critically ill patients: convection versus diffusion. Crit Care, 2006, 10(2): R67.
27.	Davies H, Leslie G. Maintaining the CRRT circuit: non-anticoagulant alternatives. Aust Crit Care, 2006, 19(4): 133-138.
28.	Dunn WJ, Sriram S. Filter lifespan in critically ill adults receiving continuous renal replacement therapy: the effect of patient and treatment-related variables. Crit Care Resusc, 2014, 16(3): 225-231.
29.	Baldwin I. Factors affecting circuit patency and filter ‘life’. Contrib Nephrol, 2007, 156: 178-184.
30.	楊濱瑜, 劉彩虹, 趙宇亮. 連續性腎臟替代治療中的血流速度: 現狀與展望. 實用心電與臨床診療, 2025, 34(1): 136-142.
31.	Ramesh Prasad GV, Palevsky PM, Burr R, et al. Factors affecting system clotting in continuous renal replacement therapy: results of a randomized, controlled trial. Clin Nephrol, 2000, 53(1): 55-60.
32.	中華醫學會腎臟病學分會專家組. 連續性腎臟替代治療的抗凝管理指南. 中華腎臟病雜志, 2022, 38(11): 1016-1024.
33.	Kleger GR, F?ssler E. Can circuit lifetime be a quality indicator in continuous renal replacement therapy in the critically ill?. Int J Artif Organs, 2010, 33(3): 139-146.
34.	丁致強, 張留平, 王越, 等. 適時再次肝素沖洗法在重癥高危患者無抗凝劑 CRRT 治療護理應用效果分析. 當代臨床醫刊, 2022, 35(3): 19-21.
35.	王露聰, 周國蓮, 趙娜, 等. CRRT 管路預沖完成后不同時間的肝素液浸泡對濾器壽命的影響. 醫藥前沿, 2024, 14(34): 14-17, 22.
36.	Panphanpho S, Naowapanich S, Ratanarat R. Use of saline flush to prevent filter clotting in continuous renal replacement therapy without anticoagulant. J Med Assoc Thai, 2011, 94(Suppl 1): S105-S110.
37.	李麗珠, 洪瓊君, 程本坤. 生理鹽水沖管在無肝素 CRRT 治療中的效果觀察. 國際醫藥衛生導報, 2014, 20(21): 3342-3344.
38.	王麗君, 沈雪云, 褚志強, 等. 生理鹽水沖管頻率對無肝素 CRRT 治療患者血流感染的影響分析. 中華醫院感染學雜志, 2018, 28(1): 58-61.
39.	Uchino S, Fealy N, Baldwin I, et al. Pre-dilution vs. post-dilution during continuous veno-venous hemofiltration: impact on filter life and azotemic control. Nephron Clin Pract, 2003, 94(4): c94-c98.
40.	van der Voort PH, Gerritsen RT, Kuiper MA, et al. Filter run time in CVVH: pre- versus post-dilution and nadroparin versus regional heparin-protamine anticoagulation. Blood Purif, 2005, 23(3): 175-180.
41.	張敏, 段棣飛, 張凌, 等. 2 種不同稀釋方式在連續性靜脈-靜脈血液透析濾過治療中應用效果分析. 中國血液凈化, 2019, 18(12): 822-825.
42.	張敏, 王芳, 孫獻坤, 等. 置換液不同稀釋方式對無抗凝連續性腎臟替代治療體外循環壽命及小分子清除率的影響研究. 華西醫學, 2022, 37(11): 1686-1689.

1. Boldt D, Busse L, Chawla LS, et al. Anticoagulation practices for continuous renal replacement therapy: a survey of physicians from the United States. Ren Fail, 2023, 45(2): 2290932.
2. Ward DM, Mehta RL. Extracorporeal management of acute renal failure patients at high risk of bleeding. Kidney Int Suppl, 1993, 41: S237-S244.
3. van de Wetering J, Westendorp RG, van der Hoeven JG, et al. Heparin use in continuous renal replacement procedures: the struggle between filter coagulation and patient hemorrhage. J Am Soc Nephrol, 1996, 7(1): 145-150.
4. Uchino S, Bellomo R, Morimatsu H, et al. Continuous renal replacement therapy: a worldwide practice survey. The beginning and ending supportive therapy for the kidney (B.E.S.T. kidney) investigators. Intensive Care Med, 2007, 33(9): 1563-1570.
5. RENAL replacement therapy study investigators, Bellomo R, Cass A, et al. Intensity of continuous renal-replacement therapy in critically ill patients. N Engl J Med, 2009, 361(17): 1627-1638.
6. Fealy N, Aitken L, du Toit E, et al. Faster blood flow rate does not improve circuit life in continuous renal replacement therapy: a randomized controlled trial. Crit Care Med, 2017, 45(10): e1018-e1025.
7. Chua HR, Baldwin I, Bailey M, et al. Circuit lifespan during continuous renal replacement therapy for combined liver and kidney failure. J Crit Care, 2012, 27(6): 744.e7-15.
8. Zhang W, Bai M, Zhang L, et al. Development and external validation of a model for predicting sufficient filter lifespan in anticoagulation-free continuous renal replacement therapy patients. Blood Purif, 2022, 51(8): 668-678.
9. Ratanarat R, Phairatwet P, Khansompop S, et al. Customized citrate anticoagulation versus no anticoagulant in continuous venovenous hemofiltration in critically ill patients with acute kidney injury: a prospective randomized controlled trial. Blood Purif, 2023, 52(5): 455-463.
10. Smith SA, Travers RJ, Morrissey JH. How it all starts: initiation of the clotting cascade. Crit Rev Biochem Mol Biol, 2015, 50(4): 326-336.
11. 尹彥玲, 趙聰聰, 胡振杰, 等. 高危出血風險患者無抗凝連續性腎臟替代治療中 AN69 ST 膜對濾器壽命影響的研究. 中華危重病急救醫學, 2015(5): 343-348.
12. Wong ET, Ong V, Remani D, et al. Filter life and safety of heparin-grafted membrane for continuous renal replacement therapy - a randomized controlled trial. Semin Dial, 2021, 34(4): 300-308.
13. Naorungroj T, Baldwin I, Eastwood G, et al. The effect of the AN69 ST100 versus oXiris^? membrane on filter life during CRRT for non-anticoagulated liver failure patients. Int J Artif Organs, 2023, 46(4): 209-214.
14. Crosswell A, Brain MJ, Roodenburg O. Vascular access site influences circuit life in continuous renal replacement therapy. Crit Care Resusc, 2014, 16(2): 127-130.
15. Brain M, Winson E, Roodenburg O, et al. Non anti-coagulant factors associated with filter life in continuous renal replacement therapy (CRRT): a systematic review and meta-analysis. BMC Nephrol, 2017, 18(1): 69.
16. Hackbarth R, Bunchman TE, Chua AN, et al. The effect of vascular access location and size on circuit survival in pediatric continuous renal replacement therapy: a report from the PPCRRT registry. Int J Artif Organs, 2007, 30(12): 1116-1121.
17. Smith T, Kaufman C, Quencer K. Internal jugular central venous catheter tip migration: patient and procedural factors. Tomography, 2022, 8(2): 1033-1040.
18. Girardot T, Monard C, Rimmelé T. Dialysis catheters in the ICU: selection, insertion and maintenance. Curr Opin Crit Care, 2018, 24(6): 469-475.
19. Raina R, Sethi S, Khooblall A, et al. Non-anticoagulation pediatric continuous renal replacement therapy methods to increase circuit life. Hemodial Int, 2022, 26(2): 147-159.
20. Fealy N, Kim I, Baldwin I, et al. A comparison of the Niagara and Medcomp catheters for continuous renal replacement therapy. Ren Fail, 2013, 35(3): 308-313.
21. Kim I, Fealy N, Baldwin I, et al. A comparison of the Niagara^? and Dolphin^? catheters for continuous renal replacement therapy. Int J Artif Organs, 2011, 34(11): 1061-1066.
22. Meier P, Meier R, Turini P, et al. Prolonged catheter survival in patients with acute kidney injury on continuous renal replacement therapy using a less thrombogenic micropatterned polymer modification. Nephrol Dial Transplant, 2011, 26(2): 628-635.
23. Zhou Z, Liu C, Li P, et al. A randomized controlled trial of catheters with different tips and lengths for patients requiring continuous renal replacement therapy in intensive care unit. Crit Care, 2025, 29(1): 148.
24. Joannidis M, Oudemans-van Straaten HM. Clinical review: patency of the circuit in continuous renal replacement therapy. Crit Care, 2007, 11(4): 218.
25. Davies HT, Leslie G, Pereira SM, et al. A randomized comparative crossover study to assess the affect on circuit life of varying pre-dilution volume associated with CVVH and CVVHDF. Int J Artif Organs, 2008, 31(3): 221-227.
26. Ricci Z, Ronco C, Bachetoni A, et al. Solute removal during continuous renal replacement therapy in critically ill patients: convection versus diffusion. Crit Care, 2006, 10(2): R67.
27. Davies H, Leslie G. Maintaining the CRRT circuit: non-anticoagulant alternatives. Aust Crit Care, 2006, 19(4): 133-138.
28. Dunn WJ, Sriram S. Filter lifespan in critically ill adults receiving continuous renal replacement therapy: the effect of patient and treatment-related variables. Crit Care Resusc, 2014, 16(3): 225-231.
29. Baldwin I. Factors affecting circuit patency and filter ‘life’. Contrib Nephrol, 2007, 156: 178-184.
30. 楊濱瑜, 劉彩虹, 趙宇亮. 連續性腎臟替代治療中的血流速度: 現狀與展望. 實用心電與臨床診療, 2025, 34(1): 136-142.
31. Ramesh Prasad GV, Palevsky PM, Burr R, et al. Factors affecting system clotting in continuous renal replacement therapy: results of a randomized, controlled trial. Clin Nephrol, 2000, 53(1): 55-60.
32. 中華醫學會腎臟病學分會專家組. 連續性腎臟替代治療的抗凝管理指南. 中華腎臟病雜志, 2022, 38(11): 1016-1024.
33. Kleger GR, F?ssler E. Can circuit lifetime be a quality indicator in continuous renal replacement therapy in the critically ill?. Int J Artif Organs, 2010, 33(3): 139-146.
34. 丁致強, 張留平, 王越, 等. 適時再次肝素沖洗法在重癥高危患者無抗凝劑 CRRT 治療護理應用效果分析. 當代臨床醫刊, 2022, 35(3): 19-21.
35. 王露聰, 周國蓮, 趙娜, 等. CRRT 管路預沖完成后不同時間的肝素液浸泡對濾器壽命的影響. 醫藥前沿, 2024, 14(34): 14-17, 22.
36. Panphanpho S, Naowapanich S, Ratanarat R. Use of saline flush to prevent filter clotting in continuous renal replacement therapy without anticoagulant. J Med Assoc Thai, 2011, 94(Suppl 1): S105-S110.
37. 李麗珠, 洪瓊君, 程本坤. 生理鹽水沖管在無肝素 CRRT 治療中的效果觀察. 國際醫藥衛生導報, 2014, 20(21): 3342-3344.
38. 王麗君, 沈雪云, 褚志強, 等. 生理鹽水沖管頻率對無肝素 CRRT 治療患者血流感染的影響分析. 中華醫院感染學雜志, 2018, 28(1): 58-61.
39. Uchino S, Fealy N, Baldwin I, et al. Pre-dilution vs. post-dilution during continuous veno-venous hemofiltration: impact on filter life and azotemic control. Nephron Clin Pract, 2003, 94(4): c94-c98.
40. van der Voort PH, Gerritsen RT, Kuiper MA, et al. Filter run time in CVVH: pre- versus post-dilution and nadroparin versus regional heparin-protamine anticoagulation. Blood Purif, 2005, 23(3): 175-180.
41. 張敏, 段棣飛, 張凌, 等. 2 種不同稀釋方式在連續性靜脈-靜脈血液透析濾過治療中應用效果分析. 中國血液凈化, 2019, 18(12): 822-825.
42. 張敏, 王芳, 孫獻坤, 等. 置換液不同稀釋方式對無抗凝連續性腎臟替代治療體外循環壽命及小分子清除率的影響研究. 華西醫學, 2022, 37(11): 1686-1689.

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Strategies for extending the lifespan of extracorporeal circulation circuit in non-anticoagulated continuous renal replacement therapy

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