title: Patterns and Mechanisms of Artificial Kidney Failure during Continuous Renal Replacement Therapy.
abstract: BACKGROUND
  We aimed to describe the previously unstudied relationship between circuit pressures and circuit clotting, here labeled as 'artificial kidney failure' (AKF), in patients receiving continuous renal replacement therapy (CRRT).
  
  
  METHODS
  We performed an observational study of CRRT-treated critically ill patients to continuously record the multiple CRRT circuit pressures.
  
  
  RESULTS
  Three patterns of access outflow dysfunction (AOD) were also noted: severe, moderate and mild. Compared with circuits without AOD, circuits experiencing at least one AOD episode had shorter lifespans (14.2 ± 12.7 vs. 21.3 ± 16.5 h, p = 0.057). This effect was more obvious with moderate or severe AOD (8.7 ± 4.6 vs. 20.6 ± 15.7 h, p = 0.007). If any AOD events occurred within the first 4 h, the sensitivity and specificity in predicting early-immediate AKF were 53.4 and 94.4%, respectively.
  
  
  CONCLUSIONS
  Early and intermediate AKF during CRRT is most likely dependent on AOD, which is a frequent event with variable severity.
authors.affiliation: Department of Nephrology, West China Hospital of Sichuan University, Sichuan, Chengdu, China.
authors.forename: Ling
authors.initials: L
authors.lastname: Zhang
authors.forename: Aiko
authors.initials: A
authors.lastname: Tanaka
authors.forename: Guijun
authors.initials: G
authors.lastname: Zhu
authors.forename: Ian
authors.initials: I
authors.lastname: Baldwin
authors.forename: Glenn M
authors.initials: GM
authors.lastname: Eastwood
authors.forename: Rinaldo
authors.initials: R
authors.lastname: Bellomo
mesh_terms: D058186:Acute Kidney Injury / Q000503:physiopathology / Q000628:therapy*; D000328:Adult; D000368:Aged; D016638:Critical Illness; D004868:Equipment Failure; D019544:Equipment Failure Analysis; D005112:Extracorporeal Circulation / Q000295:instrumentation; D005260:Female; D006801:Humans; D007688:Kidneys, Artificial; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D017582:Renal Replacement Therapy / Q000295:instrumentation*