Circuit lifespan during continuous renal replacement therapy for combined liver and kidney failure ☆,☆☆,★ Horng-Ruey Chua MBBS a,d , Ian Baldwin PhD a,b , Michael Bailey MD c , Ashwin Subramaniam MBBS a , Rinaldo Bellomo MD a,c, ⁎ a Department of Intensive Care, Austin Hospital, Melbourne, Australia b RMIT University, School of Nursing and Health Sciences, Melbourne, Australia c Australian and New Zealand Intensive Care Research Committee (ANZIC-RC), Monash University, School of Public Health and Preventive Medicine, Melbourne, Australia d Division of Nephrology, University Medicine Cluster, National University Hospital, National University Health System, Singapore Keywords: Acute liver failure; Acute kidney injury; Bleeding risk; Circuit life; Cirrhosis; Continuous renal replacement therapy; Decompensated chronic liver disease; No anticoagulation; Thrombocytopenia Abstract Purpose: To evaluate circuit lifespan (CL) and bleeding risk during continuous renal replacement therapy (CRRT), in combined liver and renal failure. Methods: Single-center retrospective analysis of adults with acute liver failure or decompensated cirrhosis who received CRRT, without anticoagulation or with heparinization in intensive care unit. Results: Seventy-one patients with 539 CRRT circuits were evaluated. Median overall CL was 9 (6–16) hours. CL was 12 (7-24) hours in 51 patients never anticoagulated for CRRT. In 20 patients who subsequently received heparinization, CL was 7 (5-11) hours without anticoagulation, which did not improve with systemic or regional heparinization (P = .231), despite higher peri-circuit activated partial thromboplastin time (APTT) and heparin dose. Using multivariate linear regression, patients with higher baseline APTT or serum bilirubin, or who were not mechanically ventilated, had longer CL (P b .05). Additionally, peri-circuit thrombocytopenia (P b .0001) or higher international normalized ratio (P b .05) predicted longer CL. Of 71 patients, 33 had significant bleeding events. Using multivariate logistic regression, patients with higher baseline APTT, vasoactive drug use N24 hours, or thrombocytopenia, had more bleeding complications (P b .05). Decreasing platelet counts (especially b50 × 10 9 /mm 3 ) had an incremental effect on CL (P b .0001). Conclusion: CRRT CL is short in patients with liver failure despite apparent coagulopathy. Thrombocytopenia predicts longer CL and bleeding complications. © 2012 Elsevier Inc. All rights reserved. ☆ The authors confirm that the results presented in this paper have not been published previously in whole or part, except in abstract form. ☆☆ Disclosures/Conflicts of Interest. The authors have no conflicts of interest to declare. ★ Contributions: HRC, IB, and RB conceived the study idea and proposal, and developed the study design. HRC, IB, and AS collected the data. HRC, MB, and RB analyzed the data. HRC and RB wrote the manuscript. All authors were involved in the revision of the manuscript, and take responsibility of the data and the contents of the article. ⁎ Corresponding author. Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Melbourne, Victoria 3181, Australia. Tel.: +61 3 9496 5992; fax: +61 3 9496 3932. E-mail address: rinaldo.bellomo@austin.org.au (R. Bellomo). 0883-9441/$ – see front matter © 2012 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jcrc.2012.08.016 Journal of Critical Care (2012) 27, 744.e7–744.e15