Epoprostenol demonstrated equivalent median filter lifespan (38 vs 27 hours, p=0.57) compared to heparin or citrate in children ≤10 kg on continuous kidney replacement therapy.
Does epoprostenol improve filter lifespan compared to heparin or citrate in children ≤10 kg on continuous kidney replacement therapy?
Epoprostenol provides comparable filter lifespan and safety profiles to heparin or citrate for continuous kidney replacement therapy in critically ill children weighing ≤10 kg.
Absolute Event Rate: 0% vs 0%
Introduction: Epoprostenol, a novel anticoagulant for pediatric continuous kidney replacement therapy (CKRT), is easier to dose and administer than heparin or citrate but has potential vasodilatory effects and lacks data in children ≤10 kg. This group experiences high CKRT related mortality, poor vasodilation tolerance, and frequent filter clotting. We hypothesize that in children ≤10 kg on CKRT epoprostenol will provide comparable filter lifespan to heparin and citrate. Methods: This is a retrospective study of children ≤10 kg on CKRT without ECMO admitted to our tertiary PICU from 2016-2025. Unpaired t test of logarithmic transformed data was used to compare lifespan between filters anticoagulated with heparin or citrate vs epoprostenol. Mixed effect analysis was used to examine effects of anticoagulant and patient factor on filter lifespan, to account for repeated measures, and to examine effects of anticoagulant and CKRT on platelets and vasoactive ionotropic score (VIS). Results: Seventy-three filters (heparin/citrate n=57, 78%; epoprostenol n=16, 22%) on 25 patients were evaluated. Notable demographics include female sex n=7 (28%), median age 14 weeks (IQR 0.7-52), median weight 4.5kg (IQR 3.1-9.1), and median Pediatric Index of Mortality-3 score 3.8 (IQR 1.7-18). Median filter duration was 27hrs (IQR 9-56) for heparin/citrate vs 38hrs (IQR 10-88) for epoprostenol (p=0.57). For each patient’s initial filter, heparin or citrate was used in 22 (85%) cases and epoprostenol in 4 (15%) cases. Initial circuits had similar median lifespans (heparin/citrate 39hrs (IQR 6.3-64) vs epoprostenol 63hrs (IQR 11-265), p=0.35). Platelet count was affected by CKRT initiation (p=0.029) but not anticoagulant type (p=0.56), with platelet count decreasing after starting CKRT. VIS was not affected by CKRT initiation (p=0.83) or anticoagulation choice (p=0.42). Of the 11 patients (42%) who had echocardiogram data, 10 (91%) had a shunt (ASD, PFO, or PDA) and none had a change in directionality of shunting after CKRT and circuit anticoagulation. Conclusions: Epoprostenol anticoagulation in CKRT has equivalent filter lifespan, effects on platelet count, and VIS compared to heparin or citrate in children ≤ 10 kg. A larger cohort may elucidate differences in the future.
Dorcin et al. (Sun,) reported a other. Epoprostenol demonstrated equivalent median filter lifespan (38 vs 27 hours, p=0.57) compared to heparin or citrate in children ≤10 kg on continuous kidney replacement therapy.
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