{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T22:12:44Z","timestamp":1784844764517,"version":"3.55.0"},"reference-count":76,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2022,1,5]],"date-time":"2022-01-05T00:00:00Z","timestamp":1641340800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Hemodialysis International"],"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Acute kidney injury (AKI) is a clinical condition characterized by an abrupt increase in serum creatinine levels due to functional changes in the kidneys from a newfound insult or injury. For supportive treatment, continuous renal replacement therapy (CRRT) is one of the most widely used modalities due to its precise control of fluid balance over extended periods of time. However, its complications include circuit clotting, the most frequent cause for CRRT interruption. Vascular access and circuit management were found to be major determinants of performance efficiency. Anticoagulation required to prevent clotting has the downside of increasing the risk of bleeding, especially in the setting of overdosage. Hence, a delicate balance needs to be maintained consistently.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This study explores the adequacy of non\u2010anticoagulation measures in the prevention of circuit clotting. A comprehensive literature search was conducted using PubMed\/Medline and Embase databases to include all relevant studies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Findings<\/jats:title><jats:p>The most\u2010effective CRRT catheter would be made of nonthrombogenic material, noncuffed and nontunneled with separate lumens for arterial and venous blood. Further, studies show that blood flow during the process is optimized at 200\u2009ml\/min, which can be lowered in the pediatric population due to more narrow catheters. Platelet count and hematocrit need to be closely monitored as levels above 450,000 \u00d7\u200910<jats:sup>6<\/jats:sup>\/L and 0.40, respectively, increase risk of clotting. Predilution is a non\u2010anticoagulation technique to reduce the risk of clotting by returning replacement solution to the blood before it reaches the filter. Also, biocompatible membranes such as polyacrylonitrile or polysulfone activate the coagulation cascade significantly less than the conventional cellulose\u2010based membranes, thereby reducing clotting chances.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussions<\/jats:title><jats:p>With the advent of such techniques and maneuvers, anticoagulation can be efficiently maintained in patients undergoing CRRT without increasing the risk of bleeding.<\/jats:p><\/jats:sec>","DOI":"10.1111\/hdi.13003","type":"journal-article","created":{"date-parts":[[2022,1,6]],"date-time":"2022-01-06T06:20:18Z","timestamp":1641450018000},"page":"147-159","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Non\u2010anticoagulation pediatric continuous renal replacement therapy methods to increase circuit life"],"prefix":"10.1111","volume":"26","author":[{"given":"Rupesh","family":"Raina","sequence":"first","affiliation":[{"name":"Akron Nephrology Associates Cleveland Clinic Akron General Medical Center  Akron Ohio USA"},{"name":"Department of Nephrology Akron Children's Hospital  Akron Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sidharth","family":"Sethi","sequence":"additional","affiliation":[{"name":"Pediatric Nephrology, Kidney Institute, Medanta The Medicity Hospital  Gurgaon Haryana India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amrit","family":"Khooblall","sequence":"additional","affiliation":[{"name":"Akron Nephrology Associates Cleveland Clinic Akron General Medical Center  Akron Ohio USA"},{"name":"Department of Nephrology Akron Children's Hospital  Akron Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vijay","family":"Kher","sequence":"additional","affiliation":[{"name":"Pediatric Nephrology, Kidney Institute, Medanta The Medicity Hospital  Gurgaon Haryana India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9290-129X","authenticated-orcid":false,"given":"Shweta","family":"Deshpande","sequence":"additional","affiliation":[{"name":"Akron Nephrology Associates Cleveland Clinic Akron General Medical Center  Akron Ohio USA"},{"name":"Department of Nephrology Akron Children's Hospital  Akron Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keval","family":"Yerigeri","sequence":"additional","affiliation":[{"name":"Department of Medicine Northeast Ohio Medical University  Rootstown Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aadi","family":"Pandya","sequence":"additional","affiliation":[{"name":"Akron Nephrology Associates Cleveland Clinic Akron General Medical Center  Akron Ohio USA"},{"name":"Department of Nephrology Akron Children's Hospital  Akron Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikhil","family":"Nair","sequence":"additional","affiliation":[{"name":"Akron Nephrology Associates Cleveland Clinic Akron General Medical Center  Akron Ohio USA"},{"name":"Department of Nephrology Akron Children's Hospital  Akron Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nithin","family":"Datla","sequence":"additional","affiliation":[{"name":"Akron Nephrology Associates Cleveland Clinic Akron General Medical Center  Akron Ohio USA"},{"name":"Department of Nephrology Akron Children's Hospital  Akron Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2876-4785","authenticated-orcid":false,"given":"Mignon","family":"McCulloch","sequence":"additional","affiliation":[{"name":"Red Cross War Memorial Children's Hospital University of Cape Town  Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy","family":"Bunchman","sequence":"additional","affiliation":[{"name":"Pediatric Nephrology &amp; Transplantation Children's Hospital of Richmond at VCU  Richmond Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4467-6833","authenticated-orcid":false,"given":"Andrew","family":"Davenport","sequence":"additional","affiliation":[{"name":"University College London Centre for Nephrology, Division of Medicine University College London Medical School, Royal Free Hospital  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,1,5]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpa.2017.08.005"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/00003246-200002000-00022"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1523-1755.1999.00397.x"},{"key":"e_1_2_13_5_1","first-page":"F1000","article-title":"Renal replacement therapy","volume":"5","author":"Ricci Z","year":"2016","journal-title":"F1000 Faculty Rev\u2010103"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1014475"},{"issue":"2","key":"e_1_2_13_7_1","first-page":"95","article-title":"Pharmacological and clinical differences between low\u2010molecular\u2010weight heparins: implications for prescribing practice and therapeutic interchange","volume":"35","author":"Merli GJ","year":"2010","journal-title":"P T"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/j.1875-9114.1990.tb02594.x"},{"key":"e_1_2_13_9_1","first-page":"164","article-title":"Precise anticoagulation for routine hemodialysis","volume":"92","author":"Farrell PC","year":"1978","journal-title":"J Lab Clin Med"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.coph.2011.12.002"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s001340050760"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/00003246-198908000-00002"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0038-1661563"},{"key":"e_1_2_13_14_1","first-page":"418","article-title":"Perturbation of the kallikrein\u2010kinin system in the adult respiratory distress syndrome","volume":"58","author":"Walshe K","year":"1987","journal-title":"Thromb Haemost"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0038-1645960"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s001340000676"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s001340050288"},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.1186\/cc4853"},{"key":"e_1_2_13_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e3181d454b3"},{"key":"e_1_2_13_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvir.2013.05.035"},{"key":"e_1_2_13_21_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2012.01.021"},{"key":"e_1_2_13_22_1","doi-asserted-by":"publisher","DOI":"10.1038\/ki.1990.300"},{"key":"e_1_2_13_23_1","doi-asserted-by":"publisher","DOI":"10.1159\/000477609"},{"issue":"5","key":"e_1_2_13_24_1","first-page":"648","article-title":"Role of prostacyclin (epoprostenol) as anticoagulant in continuous renal replacement therapies: efficacy, security and cost analysis","volume":"19","author":"Gainza FJ","year":"2006","journal-title":"J Nephrol"},{"key":"e_1_2_13_25_1","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfq225"},{"key":"e_1_2_13_26_1","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000000860"},{"key":"e_1_2_13_27_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00467-013-2690-6"},{"key":"e_1_2_13_28_1","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfh817"},{"key":"e_1_2_13_29_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00467-003-1328-5"},{"key":"e_1_2_13_30_1","doi-asserted-by":"publisher","DOI":"10.1186\/cc6965"},{"key":"e_1_2_13_31_1","first-page":"313","article-title":"Argatroban anticoagulation during renal replacement therapy","volume":"20","author":"Reddy BV","year":"2002","journal-title":"Blood Purif"},{"key":"e_1_2_13_32_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00281-011-0280-x"},{"key":"e_1_2_13_33_1","doi-asserted-by":"publisher","DOI":"10.1186\/cc5937"},{"key":"e_1_2_13_34_1","doi-asserted-by":"publisher","DOI":"10.1177\/039139889101401102"},{"key":"e_1_2_13_35_1","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.V391563"},{"key":"e_1_2_13_36_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1523-1755.1998.00837.x"},{"key":"e_1_2_13_37_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-94-011-4722-4_22"},{"key":"e_1_2_13_38_1","volume-title":"StatPearls","author":"Kushner A","year":"2020"},{"key":"e_1_2_13_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1036-7314(06)80026-3"},{"key":"e_1_2_13_40_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1492-7535.2003.00022.x"},{"key":"e_1_2_13_41_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1523-1755.2001.00009.x"},{"key":"e_1_2_13_42_1","doi-asserted-by":"publisher","DOI":"10.1177\/039139880703001212"},{"key":"e_1_2_13_43_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12882-017-0445-5"},{"key":"e_1_2_13_44_1","unstructured":"MottesT SutherlandS SymonsJ.Pediatric dialysis techniques 1: patient assessment prescription dosing delivery implementation and monitoring. Oral presentation at: International Conference on Advances in Critical Care Nephrology;2015; San Diego CA."},{"key":"e_1_2_13_45_1","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.V981507"},{"key":"e_1_2_13_46_1","doi-asserted-by":"publisher","DOI":"10.1186\/cc5101"},{"key":"e_1_2_13_47_1","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2004100870"},{"key":"e_1_2_13_48_1","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfl606"},{"key":"e_1_2_13_49_1","volume-title":"StatPearls [internet]","author":"Rivard AB","year":"2020"},{"key":"e_1_2_13_50_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12098-019-03150-9"},{"key":"e_1_2_13_51_1","series-title":"Contributions to nephrology","first-page":"191","volume-title":"Sepsis, kidney and multiple organ dysfunction","author":"Ronco C","year":"2004"},{"key":"e_1_2_13_52_1","first-page":"S142","article-title":"Temporary vascular access for extracorporeal renal replacement therapies in acute renal failure patients","volume":"66","author":"Canaud B","year":"1998","journal-title":"Kidney Int Suppl"},{"key":"e_1_2_13_53_1","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0b013e318297626e"},{"key":"e_1_2_13_54_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-002-1249-y"},{"key":"e_1_2_13_55_1","doi-asserted-by":"publisher","DOI":"10.1177\/039139888000300409"},{"key":"e_1_2_13_56_1","first-page":"S57","article-title":"On\u2010line hemodiafiltration: technique and efficiency","volume":"16","author":"Pedrini LA","year":"2003","journal-title":"J Nephrol"},{"key":"e_1_2_13_57_1","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.02410220"},{"key":"e_1_2_13_58_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMct1206045"},{"key":"e_1_2_13_59_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-016-1489-9"},{"key":"e_1_2_13_60_1","doi-asserted-by":"publisher","DOI":"10.1159\/000072492"},{"key":"e_1_2_13_61_1","doi-asserted-by":"publisher","DOI":"10.1159\/000083938"},{"key":"e_1_2_13_62_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0272-6386(97)90538-2"},{"key":"e_1_2_13_63_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5223(03)01323-0"},{"issue":"6","key":"e_1_2_13_64_1","first-page":"565","article-title":"Hazards of nitrous oxide administration in presence of venous air embolism","volume":"13","author":"Sibai AN","year":"1996","journal-title":"Middle East J Anesthesiol"},{"key":"e_1_2_13_65_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.128.4.2918"},{"key":"e_1_2_13_66_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-200401000-00015"},{"key":"e_1_2_13_67_1","first-page":"101","article-title":"Bubble\u2010induced aggregation of platelets: effects of gas species, proteins, and decompression","volume":"20","author":"Thorsen T","year":"1993","journal-title":"Undersea Hyperb Med"},{"key":"e_1_2_13_68_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.92.5.1148"},{"key":"e_1_2_13_69_1","first-page":"946","article-title":"Interactions between gas bubbles and components of the blood: implications in decompression sickness","volume":"43","author":"Philp RB","year":"1972","journal-title":"Aerosp Med"},{"key":"e_1_2_13_70_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0272-6386(00)70207-1"},{"key":"e_1_2_13_71_1","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/15.9.1420"},{"key":"e_1_2_13_72_1","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/17.3.462"},{"key":"e_1_2_13_73_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1525-1594.2007.00352.x"},{"key":"e_1_2_13_74_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1525-1594.2007.00358.x"},{"key":"e_1_2_13_75_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1525-1594.2011.01415.x"},{"key":"e_1_2_13_76_1","doi-asserted-by":"publisher","DOI":"10.1111\/hdi.12052"},{"key":"e_1_2_13_77_1","doi-asserted-by":"publisher","DOI":"10.1177\/039139880803100407"}],"container-title":["Hemodialysis International"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/hdi.13003","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/hdi.13003","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/hdi.13003","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,25]],"date-time":"2023-08-25T12:16:22Z","timestamp":1692965782000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/hdi.13003"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,5]]},"references-count":76,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2022,4]]}},"alternative-id":["10.1111\/hdi.13003"],"URL":"https:\/\/doi.org\/10.1111\/hdi.13003","archive":["Portico"],"relation":{},"ISSN":["1492-7535","1542-4758"],"issn-type":[{"value":"1492-7535","type":"print"},{"value":"1542-4758","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1,5]]},"assertion":[{"value":"2021-09-23","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-12-21","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-01-05","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}