• Nigel Fealy, Leanne Aitken, Eugene du Toit, Serigne Lo, and Ian Baldwin.
• 1Department of Intensive Care Medicine, Austin Hospital, Melbourne, VIC, Australia. 2School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia. 3School of Nursing and Midwifery, Deakin University, Melbourne, VIC, Australia. 4Centre for Health Practice Innovation, Griffith Health Institute, Griffith University, Brisbane, QLD, Australia. 5Intensive Care Unit, Princess Alexandra Hospital, Brisbane, QLD, Australia. 6School of Health Sciences, City, University of London, London, United Kingdom. 7School of Medical Science, Griffith University, Gold Coast, Sydney, QLD, Australia. 8Melanoma Institute Australia, Research and Biostatistics group, Wollstonecraft, NSW, Australia.
• Crit. Care Med. 2017 Oct 1; 45 (10): e1018-e1025.

ObjectivesTo determine whether blood flow rate influences circuit life in continuous renal replacement therapy.DesignProspective randomized controlled trial.SettingSingle center tertiary level ICU.PatientsCritically ill adults requiring continuous renal replacement therapy.InterventionsPatients were randomized to receive one of two blood flow rates: 150 or 250 mL/min.Measurements And Main ResultsThe primary outcome was circuit life measured in hours. Circuit and patient data were collected until each circuit clotted or was ceased electively for nonclotting reasons. Data for clotted circuits are presented as median (interquartile range) and compared using the Mann-Whitney U test. Survival probability for clotted circuits was compared using log-rank test. Circuit clotting data were analyzed for repeated events using hazards ratio. One hundred patients were randomized with 96 completing the study (150 mL/min, n = 49; 250 mL/min, n = 47) using 462 circuits (245 run at 150 mL/min and 217 run at 250 mL/min). Median circuit life for first circuit (clotted) was similar for both groups (150 mL/min: 9.1 hr [5.5-26 hr] vs 10 hr [4.2-17 hr]; p = 0.37). Continuous renal replacement therapy using blood flow rate set at 250 mL/min was not more likely to cause clotting compared with 150 mL/min (hazards ratio, 1.00 [0.60-1.69]; p = 0.68). Gender, body mass index, weight, vascular access type, length, site, and mode of continuous renal replacement therapy or international normalized ratio had no effect on clotting risk. Continuous renal replacement therapy without anticoagulation was more likely to cause clotting compared with use of heparin strategies (hazards ratio, 1.62; p = 0.003). Longer activated partial thromboplastin time (hazards ratio, 0.98; p = 0.002) and decreased platelet count (hazards ratio, 1.19; p = 0.03) were associated with a reduced likelihood of circuit clotting.ConclusionsThere was no difference in circuit life whether using blood flow rates of 250 or 150 mL/min during continuous renal replacement therapy.

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