{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T14:50:36Z","timestamp":1784127036183,"version":"3.55.0"},"reference-count":30,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"Nursing Research Special Fund of Southern Medical University","award":["Y2025015"],"award-info":[{"award-number":["Y2025015"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Int J Artif Organs"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Continuous renal replacement therapy (CRRT) plays a crucial role in the management of acute kidney injury (AKI) and fluid overload among critically ill patients. Despite its clinical significance, comprehensive real-world evidence from the Chinese population regarding the clinical application of CRRT, including anticoagulation strategies and factors influencing therapeutic efficacy, remains scarce.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This retrospective cohort study was performed to examine all CRRT treatments administered in the ICU of a tertiary Grade A hospital from July 1 to August 31, 2025. A total of 238 CRRT sessions fulfilling the inclusion criteria were analyzed. Data collected encompassed patient demographics, illness severity scores (APACHE II and SOFA), CRRT treatment parameters, anticoagulation strategies, laboratory indicators, and causes leading to treatment discontinuation. The primary outcome comprised filter survival time, which was analyzed using Kaplan\u2013Meier analysis and Cox proportional hazards models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      The analysis included 238 sessions derived from 187 patients (median age 67; 61.3% male). CVVH was the most commonly applied modality (55.9%). Meanwhile, citrate anticoagulation was employed in 49.6% of sessions, followed by heparin (28.2%). The predominant reason for discontinuation was filter clotting (33.6%). Multivariable analysis revealed that the use of citrate anticoagulation was associated with a significantly reduced risk of filter clotting compared to heparin (HR\u2009=\u20090.49, 95% CI 0.29\u20130.81,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.006). Likewise, a blood flow rate exceeding 150\u2009mL\/min was associated with a protective effect (HR\u2009=\u20090.65, 95% CI 0.43\u20130.98,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.039), whereas mechanical ventilation was associated with an increased risk of filter clotting (HR\u2009=\u20092.15, 95% CI 1.16\u20133.99,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.015). Finally, median filter survival was 38.5\u2009h for citrate, 18.0\u2009h for heparin, and 26.0\u2009h for nafamostat (log-rank\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>This real-world study demonstrates a strong association between citrate anticoagulation and extended filter lifespan during CRRT, supporting its role as the preferred anticoagulation approach in this setting. Moreover, maintaining adequate blood flow rates and adopting customized anticoagulation management for mechanically ventilated patients may further enhance CRRT efficacy. These findings collectively provide valuable real-world evidence to inform clinical decision-making.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/03913988261439936","type":"journal-article","created":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T08:08:28Z","timestamp":1776326908000},"page":"250-257","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Citrate doubles CRRT filter lifespan: A real-world Chinese cohort study"],"prefix":"10.1177","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-4548-7365","authenticated-orcid":false,"given":"Qing","family":"Ou","sequence":"first","affiliation":[{"name":"Department of Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan","family":"He","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiuying","family":"Shi","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenjuan","family":"Yan","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lengzhen","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhili","family":"Liang","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanan","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongyun","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,4,16]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(00)02430-2"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.CCM.0B013E3181611F552"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1186\/cc9358"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1186\/cc5937"},{"issue":"4","key":"e_1_3_3_6_2","first-page":"305","article-title":"Citrate versus heparin anticoagulation for continuous renal replacement therapy: a systematic review and meta-analysis of RCTs","volume":"37","author":"Zhang Z","year":"2014","unstructured":"Zhang Z, Ni H. Citrate versus heparin anticoagulation for continuous renal replacement therapy: a systematic review and meta-analysis of RCTs. Blood Purif 2014; 37(4): 305\u2013309.","journal-title":"Blood Purif"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-015-4099-0"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-016-1299-0"},{"issue":"5","key":"e_1_3_3_9_2","first-page":"1075","article-title":"Citrate anticoagulation versus systemic heparinisation in continuous venovenous haemofiltration in critically ill patients with acute kidney injury: a multi-centre randomized clinical trial","volume":"29","author":"Schilder L","year":"2014","unstructured":"Schilder L, Nurmohamed SA, ter Wee PM, et al. Citrate anticoagulation versus systemic heparinisation in continuous venovenous haemofiltration in critically ill patients with acute kidney injury: a multi-centre randomized clinical trial. Nephrol Dial Transplant 2014; 29(5): 1075\u20131082.","journal-title":"Nephrol Dial Transplant"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.18618"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jval.2017.08.3019"},{"issue":"1","key":"e_1_3_3_12_2","first-page":"1","article-title":"Kidney Disease: Improving Global Outcomes (KDIGO) clinical practice guideline for acute kidney injury","volume":"2","author":"Kellum JA","year":"2012","unstructured":"Kellum JA, Lameire N, Aspelin P, et al. Kidney Disease: Improving Global Outcomes (KDIGO) clinical practice guideline for acute kidney injury. Kidney Int Suppl 2012; 2(1): 1\u2013141.","journal-title":"Kidney Int Suppl"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-007-0754-4"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsb1609216"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfi296"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1038\/nrneph.2011.172"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfq575"},{"issue":"10","key":"e_1_3_3_18_2","article-title":"Recommendations on anticoagulation for continuous renal replacement therapy from the Acute Disease Quality Initiative (ADQI) consensus group","volume":"3","author":"Ostermann M","year":"2020","unstructured":"Ostermann M, Bellomo R, Burdmann EA, et al. Recommendations on anticoagulation for continuous renal replacement therapy from the Acute Disease Quality Initiative (ADQI) consensus group. JAMA Netw Open 2020; 3(10): e2020465.","journal-title":"JAMA Netw Open"},{"issue":"1","key":"e_1_3_3_19_2","first-page":"142","article-title":"Efficacy and safety of citrate-based anticoagulation compared to heparin in patients with acute kidney injury undergoing continuous renal replacement therapy: a randomized controlled trial","volume":"10","author":"Stucker F","year":"2020","unstructured":"Stucker F, Ponte B, Tataw J, et al. Efficacy and safety of citrate-based anticoagulation compared to heparin in patients with acute kidney injury undergoing continuous renal replacement therapy: a randomized controlled trial. Ann Intensive Care 2020; 10(1): 142.","journal-title":"Ann Intensive Care"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2369-14-232"},{"issue":"5","key":"e_1_3_3_21_2","article-title":"Regional citrate versus heparin anticoagulation for continuous kidney replacement therapy in critically ill patients: an updated systematic review and meta-analysis","volume":"50","author":"Brooks SC","year":"2022","unstructured":"Brooks SC, Anderson R, Alam SS, et al. Regional citrate versus heparin anticoagulation for continuous kidney replacement therapy in critically ill patients: an updated systematic review and meta-analysis. Crit Care Med 2022; 50(5): e400\u2013e409.","journal-title":"Crit Care Med"},{"issue":"2","key":"e_1_3_3_22_2","first-page":"173","article-title":"Citrate anticoagulation versus no anticoagulation in critically ill patients requiring continuous renal replacement therapy: a randomized controlled trial","volume":"9","author":"Lumlertgul N","year":"2021","unstructured":"Lumlertgul N, Srisawat N, Peerapornratana S, et al. Citrate anticoagulation versus no anticoagulation in critically ill patients requiring continuous renal replacement therapy: a randomized controlled trial. Lancet Respir Med 2021; 9(2): 173\u2013182.","journal-title":"Lancet Respir Med"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1097\/00003246-200104000-00010"},{"issue":"72","key":"e_1_3_3_24_2","article-title":"Pharmacokinetic principles during continuous renal replacement therapy: drugs and dosage","author":"B\u00f6hler J","year":"1999","unstructured":"B\u00f6hler J, Donauer J, Keller F. Pharmacokinetic principles during continuous renal replacement therapy: drugs and dosage. Kidney Int Suppl 1999;(72): S24\u2013S28.","journal-title":"Kidney Int Suppl"},{"issue":"4","key":"e_1_3_3_25_2","first-page":"345","article-title":"Citrate dose and filter life during regional citrate anticoagulation for continuous renal replacement therapy: a prospective observational study","volume":"48","author":"Broman M","year":"2019","unstructured":"Broman M, Klarin B, Sandin K, et al. Citrate dose and filter life during regional citrate anticoagulation for continuous renal replacement therapy: a prospective observational study. Blood Purif 2019; 48(4): 345\u2013353.","journal-title":"Blood Purif"},{"issue":"2","key":"e_1_3_3_26_2","first-page":"135","article-title":"Anticoagulation with nafamostat mesilate, a synthetic protease inhibitor, in hemodialysis patients with a bleeding risk","volume":"23","author":"Matsuo T","year":"1993","unstructured":"Matsuo T, Kario K, Nakao K, et al. Anticoagulation with nafamostat mesilate, a synthetic protease inhibitor, in hemodialysis patients with a bleeding risk. Haemostasis 1993; 23(2): 135\u2013141.","journal-title":"Haemostasis"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1186\/s40001-024-01660-7"},{"issue":"1","key":"e_1_3_3_28_2","first-page":"273","article-title":"Predictors of filter life in continuous venovenous hemofiltration with regional citrate anticoagulation","volume":"21","author":"Schilder L","year":"2017","unstructured":"Schilder L, Nurmohamed SA, Bosch FH, et al. Predictors of filter life in continuous venovenous hemofiltration with regional citrate anticoagulation. Crit Care 2017; 21(1): 273.","journal-title":"Crit Care"},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-004-2440-0"},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-020-02880-z"},{"key":"e_1_3_3_31_2","doi-asserted-by":"publisher","DOI":"10.1159\/000190784"}],"container-title":["The International Journal of Artificial Organs"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/03913988261439936","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/03913988261439936","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/03913988261439936","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T06:02:55Z","timestamp":1777528975000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/03913988261439936"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4]]},"references-count":30,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,4]]}},"alternative-id":["10.1177\/03913988261439936"],"URL":"https:\/\/doi.org\/10.1177\/03913988261439936","relation":{},"ISSN":["0391-3988","1724-6040"],"issn-type":[{"value":"0391-3988","type":"print"},{"value":"1724-6040","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4]]}}}