Nurs Crit Care. 2026 Sep;31(5):e70637. doi: 10.1111/nicc.70637.
ABSTRACT
BACKGROUND: Continuous renal replacement therapy (CRRT) is the preferred renal replacement therapy for critically ill patients with acute kidney injury; however, unplanned treatment discontinuation remains a major challenge that compromises treatment efficacy and patient outcomes.
AIMS: To investigate the risk factors and temporal trends associated with unplanned CRRT discontinuation using descriptive time-series analysis and to identify evidence-based nursing interventions.
STUDY DESIGN: This retrospective cohort study was conducted at a tertiary hospital in China between January and December 2025. Univariate analysis and binary logistic regression were used to identify factors independently associated with unplanned discontinuation. Descriptive time-series analysis with 7-day moving average smoothing was applied to evaluate temporal patterns throughout the study period.
RESULTS: Unplanned discontinuation occurred in 77 of 3128 CRRT sessions (2.46%). After adjustment, anticoagulation regimen, treatment duration (p < 0.001) and net ultrafiltration rate (p = 0.032) were identified as independent predictors of unplanned discontinuation. Compared with no anticoagulation, nafamostat mesylate was associated with lower odds of unplanned CRRT discontinuation (p = 0.013), whereas sodium citrate was associated with higher odds (p = 0.004), likely reflecting centre-specific implementation factors related to low citrate utilization. Descriptive time-series analysis showed temporal fluctuations in unplanned discontinuation rates, with an apparent peak in November. Elevated circuit pressure was the leading cause of unplanned discontinuation.
CONCLUSIONS: Unplanned CRRT discontinuation was associated with anticoagulation regimen, treatment duration and ultrafiltration rate. Standardized anticoagulation protocols, staff training, safe ultrafiltration practices and enhanced circuit pressure surveillance may reduce unplanned discontinuation and improve patient outcomes.
RELEVANCE TO CLINICAL PRACTICE: These findings provide nurses with evidence-based strategies, including locally informed monitoring protocols, standardized anticoagulation checklists and circuit pressure early warning indicators, to reduce unplanned CRRT discontinuation.
PMID:42586802 | DOI:10.1111/nicc.70637
