Association between intracatheter Ca² ⁺ trajectory and extracorporeal circuit coagulation in unplanned early withdrawal among patients receiving CRRT: a retrospective cohort study
- 1Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
- 2Clinical Research Center of Hubei Critical Care Medicine, Wuhan, Hubei, China
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.
Design: Retrospective cohort study.
Setting: 3 ICU wards of a university-affiliated tertiary teaching hospital in Wuhan, China.
Participants: 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.
Main outcome measures: The primary outcome was the occurrence of extracorporeal circuit coagulation. The secondary outcome was extracorporeal circulation lifespan (filter lifespan).
Results: 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.
Conclusions: 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.
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BibTeX
@article{zhang2026association,
title = {{Association between intracatheter Ca² ⁺ trajectory and extracorporeal circuit coagulation in unplanned early withdrawal among patients receiving CRRT: a retrospective cohort study}},
author = {Yanting Zhang and Jing Ma and Guanghua Gao and Yingying Zeng and Yuting Huang and Chong Cheng and Jin Li and Xinbo Ding and Zhaoyang Li},
journal = {BMJ Open},
year = {2026},
month = oct,
doi = {10.1136/bmjopen-2026-121004},
url = {https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-121004},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Association between intracatheter Ca² ⁺ trajectory and extracorporeal circuit coagulation in unplanned early withdrawal among patients receiving CRRT: a retrospective cohort study
AU - Yanting Zhang
AU - Jing Ma
AU - Guanghua Gao
AU - Yingying Zeng
AU - Yuting Huang
AU - Chong Cheng
AU - Jin Li
AU - Xinbo Ding
AU - Zhaoyang Li
PY - 2026
DA - 2026/10/29
JO - BMJ Open
DO - 10.1136/bmjopen-2026-121004
UR - https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-121004
AB - 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. Design: Retrospective cohort study. Setting: 3 ICU wards of a university-affiliated tertiary teaching hospital in Wuhan, China. Participants: 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. Main outcome measures: The primary outcome was the occurrence of extracorporeal circuit coagulation. The secondary outcome was extracorporeal circulation lifespan (filter lifespan). Results: 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. Conclusions: 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.
SN - 2044-6055
SN - 2044-6055
ER -