ABSTRACT
Continuous renal replacement therapies (CRRTs) are increasingly being advocated to treat acute renal failure in the intensive care and high-dependency setting. The gradual removal of plasma water and azotemic toxins during CRRT provides a major advantage over intermittent dialysis techniques. However, to achieve control of azotemia comparable to daily intermittent hemodialysis/hemofiltration, the CRRT extracorporeal circuit must function continuously, 24 hours a day, day after day (1). Anticoagulants are therefore routinely used to help maintain and maximize the life of the CRRT circuit by attempting to prevent coagulation within the hemofilter/hemodialysis circuit. Inadequate anticoagulation leads initially to reduced efficiency of the CRRT circuit in terms of both solute and water clearance, followed by premature clotting of the circuit, resulting in blood loss, treatment ‘‘downtime,’’ and the additional financial costs and nursing time involved in setting up a new CRRT circuit. Excessive anticoagulation, on the other hand, may result in bleeding complications (usually minor), with a reported incidence ranging from <5% up to 26% of treatments (2,3) and, on occasion, proving fatal (4).
