PURPOSE: The choice of vascular access catheter may affect filter life during continuous renal replacement therapy (CRRT). In particular, differences in catheter design might affect the incidence of circuit clotting related to catheter malfunction.
DESIGN AND SETTING: Sequential controlled study in a tertiary, adult intensive care unit (ICU).
AIM: To compare circuit life when CRRT was performed with a Niagara catheter or a Medcomp catheter.
PATIENTS AND MEASUREMENTS: We studied 46 patients with acute kidney injury requiring CRRT, all delivered with catheters in the femoral position. We obtained information on age, gender, disease severity score [acute physiology and chronic health evaluation (APACHE II) and APACHE III], filter life, heparin dose per hour, daily systemic hemoglobin concentration, platelet count, international normalized ratio (INR), and activated partial thromboplastin time (APTT) during CRRT.
RESULTS: We studied 254 circuits in 46 patients. Of these, 26 patients (140 circuits) used the Niagara catheter and 20 patients (114 circuits) used the Medcomp catheter. Median circuit life in the two groups were 11 h and 7.3 h, respectively (p < 0.01). Patients using Medcomp catheters had a lower platelet count (p = 0.04) and a lower hemoglobin concentration (p = 0.01), but INR (p = 0.16), APTT (p = 0.46), anticoagulant treatment (p = 0.89), and heparin dose per hour (p = 0.24) were similar. After correcting for confounding variables by multivariable linear regression analysis, it was found that the choice of catheter is not an independent predictor of circuit life. On Kaplan-Meier survival analysis, circuit life was not significantly different between the two catheters (p = 0.87).
CONCLUSION: The choice of either the Niagara or Medcomp catheter does not appear to be a significant independent determinant of circuit life during CRRT.