Critical Care Nephrology – Research Article

Abramovitz B.W.a· Oguntuwase E.b· Abo-Zed A.b· DeSilva R.a

Author affiliations

aRenal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
bDepartment of Medicine, Mercy Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

Log in to MyKarger to check if you already have access to this content.

Buy FullText & PDF Unlimited re-access via MyKarger Unrestricted printing, no saving restrictions for personal use read more

CHF 38.00 *
EUR 35.00 *
USD 39.00 *

Select

KAB

Buy a Karger Article Bundle (KAB) and profit from a discount!

If you would like to redeem your KAB credit, please log in.

Save over 20% compared to the individual article price.

Learn more

Rent via DeepDyve Unlimited fulltext viewing of this article Organize, annotate and mark up articles Printing and downloading restrictions apply

Start free trial

Subscribe Access to all articles of the subscribed year(s) guaranteed for 5 years Unlimited re-access via Subscriber Login or MyKarger Unrestricted printing, no saving restrictions for personal use read more

Subcription rates

Select

* The final prices may differ from the prices shown due to specifics of VAT rules.

Article / Publication Details

First-Page Preview

Received: April 25, 2022
Accepted: November 17, 2022
Published online: March 10, 2023

Number of Print Pages: 7
Number of Figures: 0
Number of Tables: 2

ISSN: 0253-5068 (Print)
eISSN: 1421-9735 (Online)

For additional information: https://www.karger.com/BPU

Abstract

Introduction: Hypertriglyceridemia is a rarely reported cause of early continuous renal replacement therapy (CRRT) circuit clotting. Methods: We have identified and will present 11 published cases in the literature where hypertriglyceridemia has led to CRRT circuit clotting or dysfunction. Results: The majority of cases (8/11) are related to propofol use leading to hypertriglyceridemia. The other cases (3/11) are due to total parenteral nutrition administration. Conclusion: Due to the propensity of propofol use for critically ill patients in intensive care units, and the rather common occurrence of CRRT circuit clotting, hypertriglyceridemia may be underappreciated and undiagnosed. The exact pathophysiology behind hypertriglyceridemia-induced CRRT clotting has not been fully elucidated, although there are some hypotheses which include fibrin and fat droplet deposition (identified after electron microscopic examination of the hemofilter), increased blood viscosity, and development of a procoagulant state. Premature clotting poses a multitude of problems including inadequate treatment time, increased costs, increasing nursing workload, and patient blood loss. With earlier identification, discontinuation of the inciting agent, and possible therapeutic management, we could expect improvement in CRRT hemofilter patency and decreased costs.

© 2023 S. Karger AG, Basel

References Finkel KW, Podoll AS. Complications of continuous renal replacement therapy. Semin Dial. 2009;22(2):155–9. Ricci Z, Romagnoli S. Technical complications of continuous renal replacement therapy. Contrib Nephrol. 2018;194:99–108. Tolwani AJ, Wille KM. Anticoagulation for continuous renal replacement therapy. Semin Dial. 2009;22(2):141–5. Kazory A, Clapp WL, Ejaz AA, Ross EA. Shortened hemofilter survival time due to lipid infusion in continuous renal replacement therapy. Nephron Clin Pract. 2008;108(1):c5–9. Bassi E, Ferreira CB, Macedo E, Malbouisson LM. Recurrent clotting of dialysis filter associated with hypertriglyceridemia induced by propofol. Am J Kidney Dis. 2014;63(5):860–1. Rodríguez B, Wilhelm A, Kokko KE. Lipid emulsion use precluding renal replacement therapy. J Emerg Med. 2014;47(6):635–7. Kakajiwala A, Chiotos K, Brothers J, Lederman A, Amaral S. What is this chocolate milk in my circuit? A cause of acute clotting of a continuous renal replacement circuit: answers. Pediatr Nephrol. 2016;31(12):2253–5. Alsawah MY, Butcher DB, Aljundi L, Wilson RE. Propofol induced CRRT failure. American Society of Nephrology Kidney Week Abstract; 2017. McLaughlin DC, Fang DC, Nolot BA, Guru PK. Hypertriglyceridemia causing continuous renal replacement therapy dysfunction in a patient with end-stage liver disease. Indian J Nephrol. 2018;28(4):303–6. Hrizat A, Hamadah A, Patel C, Gharaibeh K. CRRT filter clotting secondary to hypertriglyceridemia in the setting of propofol and total parenteral infusions. National Kidney Foundation Spring Clinical Meetings Abstract; 2020. Parikh R, Barnett RL. Severe hypertriglyceridemia leading to CRRT malfunction in a COVID-19 patient. American Society of Nephrology Kidney Week Abstract; 2020. Whitlow M, Rajasekaran A, Rizk D. Unusual cause for continuous renal replacement therapy filter clotting. Kidney360. 2020;1(3):225–6. Samal S, Singhania N, Adl D, Afzal O, Singhania G. Chocolate milk in CRRT circuit: propofol induced hypertriglyceridemia. Am J Med Sci. 2021;361(1):135–6. Oguntuwase E, Abo-Zed A, Abramovitz B. National kidney. Foundation Spring Clinical Meetings Abstract; 2022. Macedo E, Mehta RL. Continuous dialysis therapies: core curriculum 2016. Am J Kidney Dis. 2016;68(4):645–57. Joannidis M, Oudemans-van Straaten HM. Clinical review: patency of the circuit in continuous renal replacement therapy. Crit Care. 2007;11(4):218–27. Berglund L, Brunzell JD, Goldberg AC, Goldberg IJ, Sacks F, Murad MH, et al. Evaluation and treatment of hypertriglyceridemia: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2012;97(9):2969–89. Chait A, Brunzell JD. Severe hypertriglyceridemia: role of familial and acquired disorders. Metabolism. 1983;32(3):209–14. Mirtallo JM, Ayers P, Boullata J, Gura KM, Plogsted S, Anderson CR, et al. ASPEN lipid injectable emulsion safety recommendations, Part 1: background and adult considerations. Nutr Clin Pract. 2020;35(5):769–82. Fulton B, Sorkin EM. Propofol: an overview of its pharmacology and a review of its clinical efficacy in intensive care sedation. Drugs. 1995;50(4):636–57. Devlin JW, Lau AK, Tanios MA. Propofol-associated hypertriglyceridemia and pancreatitis in the intensive care unit: an analysis of frequency and risk factors. Pharmacotherapy. 2005;25(10):1348–52. Ozanne P, Boudart D, Mainard F, Lefebvre J, Grolleau JY. Blood and plasma hyperviscosity in primary hyperlipidemia. Rev Med Interne. 1984;5(1):29–33. Chan P, Huang TY, Shieh SM, Lin TS, Tsai CW. Thrombophilia in patients with hypertriglyceridemia. J Thromb Thrombolysis. 1997;4(3/4):425–9. Yeh JH, Lee MF, Chiu HC. Plasmapheresis for severe lipemia: comparison of serum-lipid clearance rates for the plasma-exchange and double-filtration variants. J Clin Apher. 2003;18(1):32–6. Article / Publication Details

First-Page Preview

Received: April 25, 2022
Accepted: November 17, 2022
Published online: March 10, 2023

Number of Print Pages: 7
Number of Figures: 0
Number of Tables: 2

ISSN: 0253-5068 (Print)
eISSN: 1421-9735 (Online)

For additional information: https://www.karger.com/BPU

Copyright / Drug Dosage / Disclaimer Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.