{
  "abstract": "Objective: This study aims to identify the trajectory patterns of intracatheter ionised calcium (Ca2+) in Intensive Care Unit (ICU) patients who experienced unplanned early withdrawal of citrate-anticoagulated continuous renal replacement therapy (CRRT) due to extracorporeal circuit coagulation and to analyse the association between these trajectories and coagulation-induced filter lifespan reduction within this selected population.\n\nDesign: Retrospective cohort study.\n\nSetting: 3 ICU wards of a university-affiliated tertiary teaching hospital in Wuhan, China.\n\nParticipants: A total of 732 ICU patients who underwent citrate-anticoagulated CRRT and experienced unplanned early withdrawal between January 2022 and December 2023 were included. Patients who completed CRRT as planned were not included. The study population therefore represents a selected subgroup already enriched for premature circuit interruption rather than the general population of patients receiving CRRT with regional citrate anticoagulation.\n\nMain outcome measures: The primary outcome was the occurrence of extracorporeal circuit coagulation. The secondary outcome was extracorporeal circulation lifespan (filter lifespan).\n\nResults: intracatheter Ca2+ trajectories were categorised into three types: low baseline with stable trend, moderate baseline with slow decline and high baseline with rapid decline. Fibrinogen, lactic acid and nurses’ professional titles showed significant differences among the three trajectory groups. Cox regression revealed that the high baseline with rapid decline type was the high-risk group for coagulation-induced filter lifespan reduction (HR=1.0), with the moderate baseline with slow decline type (HR=0.633 (95% CI 0.425 to 0.942), p=0.024) and low baseline with stable trend type (HR=0.534 (95% CI 0.289 to 0.986), p=0.045) having lower hazards. Multivariable analysis identified factors associated with circuit coagulation, including Body Mass Index, Sequential Organ Failure Assessment score, Richmond Agitation-Sedation Scale (RASS) score, use of lipid-lowering drugs and blood-product transfusion. Higher citrate flow rate and lower transmembrane pressure were variables associated with a lower hazard of coagulation-driven filter failure. Several of these variables were measured during ongoing CRRT and may reflect downstream changes related to evolving circuit status rather than baseline causal determinants.\n\nConclusions: Heterogeneous intracatheter Ca2+ trajectories exist in patients receiving CRRT with unplanned early withdrawal due to circuit coagulation, and the high baseline with rapid decline trajectory is an independently associated factor for coagulation-induced filter lifespan reduction. These hypothesis-generating findings provide preliminary observational insights for optimising citrate anticoagulation management in CRRT; the observed intracatheter Ca2+ range among low-risk patients requires prospective external validation before any clinical implementation.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China",
    "Clinical Research Center of Hubei Critical Care Medicine, Wuhan, Hubei, China"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 9,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Yanting Zhang",
      "orcid": "0000-0003-4314-6520"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Jing Ma"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Guanghua Gao"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Yingying Zeng"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Yuting Huang"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Chong Cheng"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Jin Li"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Xinbo Ding"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Zhaoyang Li",
      "orcid": "0009-0009-8074-9866"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/exm8cnykb34px.bib",
  "cited_by": 0,
  "doi": "10.1136/bmjopen-2026-121004",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13723830/",
  "id": "exm8cnykb34px",
  "issns": [
    "2044-6055",
    "2044-6055"
  ],
  "landing_url": "https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-121004",
  "language": "en",
  "licence": "CC-BY-NC-4.0",
  "licence_label": "CC BY-NC 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "1506"
    ],
    [
      "heading",
      "1707"
    ],
    [
      "heading",
      "Intensive Care"
    ],
    [
      "heading",
      "Original Research"
    ]
  ],
  "openalex": null,
  "pdf_url": null,
  "pmcid": "PMC13723830",
  "pmid": "42957308",
  "published": "2026-10-29",
  "publisher": "BMJ",
  "ris": "https://research.draconitic.com/paper/exm8cnykb34px.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:44Z",
      "native_id": "10.1136/bmjopen-2026-121004",
      "source": "crossref",
      "url": "https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-121004"
    },
    {
      "first_seen": "2026-11-04T12:22:23Z",
      "native_id": "PMC13723830",
      "source": "pmc",
      "url": "https://doi.org/10.1136/bmjopen-2026-121004"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "journal-openalex:F27",
      "subfield": "general"
    }
  ],
  "title": "Association between intracatheter Ca² ⁺ trajectory and extracorporeal circuit coagulation in unplanned early withdrawal among patients receiving CRRT: a retrospective cohort study",
  "title_text": "Association between intracatheter Ca² ⁺ trajectory and extracorporeal circuit coagulation in unplanned early withdrawal among patients receiving CRRT: a retrospective cohort study",
  "type": "peer-reviewed",
  "updated_at": "2026-11-05T12:20:34Z",
  "url": "https://research.draconitic.com/paper/exm8cnykb34px",
  "venue": "BMJ Open",
  "versions": []
}