Frank Bidar: Why Do CRRT Filters Clot Despite Adequate Citrate Anticoagulation?
Frank Bidar, Hospital Practitioner at Lyon University Hospitals, shared a post on LinkedIn about a recent article he and his colleagues co-authored, published in Scientific Reports, adding:
“Why do CRRT filters clot despite adequate citrate anticoagulation?
Glad to share our latest study, now available online in Scientific Reports, exploring the mechanisms behind this complication.
Early and recurrent filter thrombosis despite adequate citrate anticoagulation remains a challenging issue during CRRT, recently highlighted in the 2026 KDIGO guidelines.
In this prospective multicenter study, we found:
- Adequate regional citrate anticoagulation, with post-filter ionized calcium within target in over 90% of measurements.
- No evidence of overt systemic hypercoagulability, despite marked inflammation.
- Neutrophil-rich intrafilter thrombi, with extracellular citrullinated histone H3 suggesting NET-like structures.
- These findings suggest that local thrombo-inflammation may contribute to filter thrombosis despite apparently adequate citrate anticoagulation.
An exploratory step toward a better understanding of this phenomenon and more personalized anticoagulation strategies during CRRT.
Special thanks to Nicolas Chardon and the Hemostasis Laboratory team at Hospices Civils de Lyon – HCL for their contribution to this work!”
Title: Early recurrent hemofilter thrombosis despite regional citrate anticoagulation during continuous renal replacement therapy: a prospective observational study
Authors: Nicolas Chardon, Agathe Florentin, Thomas Rimmelé, Anaelle De-Wreede, Baptiste Balança, Anne Claire Lukaszewicz, Jean-Luc Fellahi, Laurent Juillard, Giuseppe Balice, Christophe Nougier, Hamdi Rezigue, Frank Bidar
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