{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T07:01:41Z","timestamp":1790060501131,"version":"4.0.1"},"reference-count":31,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T00:00:00Z","timestamp":1787788800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T00:00:00Z","timestamp":1787788800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Nursing in Critical Care"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Prolonged CRRT downtime compromises treatment efficacy and worsens outcomes. Daily downtime &gt;\u200920% exacerbates acidosis and is associated with 28\u2010day mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>This study aimed to develop and validate a bedside\u2010accessible nomogram for early identification of treatment days at risk of suboptimal CRRT downtime control in critically ill patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>This retrospective cohort study was conducted in one Chinese ICU (January 2019\u2013December 2023). The binary outcome was cumulative downtime &gt;\u20092.4\u2009h per standardised treatment day. Variables included demographics, laboratory parameters, CRRT circuit and other treatment factors. GEE identified predictors; the model was displayed as a nomogram and assessed by AUC, calibration and decision curve analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 145 patients contributing 595 CRRT treatment days were included. Total treatment time was 14\u2009280\u2009h and cumulative downtime was 1725.07\u2009h. Mean daily downtime was 2.90\u2009\u00b1\u20092.72\u2009h (12.08%\u2009\u00b1\u200911.35% of treatment time). Suboptimal CRRT downtime control occurred on 232 treatment days (39.0%). Multivariable GEE analysis identified five independent risk factors for suboptimal downtime control: daily number of filter replacements (OR\u2009=\u20092.629, 95% CI 1.822\u20133.794,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), agitation (OR\u2009=\u20092.331, 95% CI 1.041\u20135.218,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.040), plasma exchange (OR\u2009=\u20094.654, 95% CI 1.042\u201320.782,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.044), catheter dysfunction (OR\u2009=\u200910.528, 95% CI 2.939\u201337.710,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and out\u2010of\u2010unit transport for procedures (OR\u2009=\u20097.563, 95% CI 2.663\u201321.484,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). The nomogram yielded AUCs of 0.789 (95% CI 0.726\u20130.841), 0.813 (95% CI 0.725\u20130.897) and 0.835 (95% CI 0.768\u20130.896) in the training, internal validation and external validation sets, respectively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Daily number of filter replacements, agitation, plasma exchange, catheter dysfunction and out\u2010of\u2010unit transport are independent risk factors for suboptimal CRRT downtime control. This nomogram showed satisfactory discrimination, calibration and net clinical benefit in internal and external validation, offering ICU nurses a rapid bedside risk assessment tool.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Relevance to Clinical Practice<\/jats:title>\n                    <jats:p>ICU nurses can use this nomogram at CRRT initiation to identify high\u2010risk patients and prioritise bedside procedures, sedation, catheter care and filter longevity to reduce downtime.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/nicc.70664","type":"journal-article","created":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T06:05:36Z","timestamp":1787897136000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Analysis of Factors Influencing Downtime During Continuous Renal Replacement Therapy in Critically Ill Patients and Construction of a Prediction Model"],"prefix":"10.1111","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-8562-4328","authenticated-orcid":false,"given":"Bingbing","family":"Pang","sequence":"first","affiliation":[{"name":"Department of Intensive Care Medicine The Fourth Hospital of Hebei Medical University  Shijiazhuang China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine The Fourth Hospital of Hebei Medical University  Shijiazhuang China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanshuo","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine The Fourth Hospital of Hebei Medical University  Shijiazhuang China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiaoju","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine The Fourth Hospital of Hebei Medical University  Shijiazhuang China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaihua","family":"Dong","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine The Fourth Hospital of Hebei Medical University  Shijiazhuang China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suzhi","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine The Fourth Hospital of Hebei Medical University  Shijiazhuang China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-6971-5630","authenticated-orcid":false,"given":"Yanling","family":"Yin","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine The Fourth Hospital of Hebei Medical University  Shijiazhuang China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,27]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-003-1672-8"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/1744-9987.12253"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(19)32563-2"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11739-022-03136-0"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/nicc.13265"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrc.2019.07.003"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrc.2018.06.023"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/MAT.0000000000001549"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.aucc.2016.05.004"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13613-020-0648-y"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1186\/cc5937"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/nicc.70025"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1053\/jcrc.2002.36757"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-016-4579-x"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/nicc.13179"},{"issue":"5","key":"e_1_2_12_17_1","first-page":"520","article-title":"Construction and External Validation of a Risk Prediction Model for Unplanned Interruption During Continuous Renal Replacement Therapy","volume":"36","author":"Xu H.","year":"2024","journal-title":"Zhonghua Wei Zhong Bing Ji Jiu Yi Xue"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0895-4356(96)00236-3"},{"issue":"1","key":"e_1_2_12_19_1","first-page":"S176","article-title":"KDOQI Clinical Practice Guidelines for Vascular Access","volume":"48","author":"National Kidney Foundation","year":"2006","journal-title":"American Journal of Kidney 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H.","year":"2023","journal-title":"Journal of Nursing"},{"issue":"1","key":"e_1_2_12_26_1","first-page":"86","article-title":"Filter Lifespan, Treatment Effect, and Influencing Factors of Continuous Renal Replacement Therapy for Severe Burn Patients","volume":"45","author":"Yue Q.","year":"2024","journal-title":"Journal of Burn Care & Research"},{"key":"e_1_2_12_27_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-023-04519-1"},{"key":"e_1_2_12_28_1","doi-asserted-by":"publisher","DOI":"10.1080\/0886022X.2024.2387431"},{"key":"e_1_2_12_29_1","doi-asserted-by":"publisher","DOI":"10.1159\/000534718"},{"key":"e_1_2_12_30_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12882-018-1195-8"},{"key":"e_1_2_12_31_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-020-76785-w"},{"key":"e_1_2_12_32_1","doi-asserted-by":"publisher","DOI":"10.34067\/KID.0000001037"}],"container-title":["Nursing in Critical Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/nicc.70664","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/nicc.70664","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/nicc.70664","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T06:04:37Z","timestamp":1790057077000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/nicc.70664"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,27]]},"references-count":31,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1111\/nicc.70664"],"URL":"https:\/\/doi.org\/10.1111\/nicc.70664","archive":["Portico"],"relation":{},"ISSN":["1362-1017","1478-5153"],"issn-type":[{"value":"1362-1017","type":"print"},{"value":"1478-5153","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,27]]},"assertion":[{"value":"2026-01-18","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-13","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-27","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70664"}}