Thrombocytopenia in Continuous Kidney Replacement Therapy (CKRT): A Systematic Literature Review and Assessment of its Clinical Relevance

Thrombocytopenia can increase during Continuous Kidney Replacement Therapy (CKRT) in critically ill patients. This is the first systematic review that assesses whether thrombocytopenia during CKRT is clinically relevant.

The authors comprehensively evaluated CKRT-related thrombocytopenia data. Qualitative and quantitative tools were used to assess quality and risk of bias, epidemiology, causality, clinical outcomes, and possible mitigation and management strategies in the included publications. A subset analysis using Hedges’ g was conducted to assess the impact of the various parameters of interest.

Independent review of over 9,273 records by three authors produced 119 that met the inclusion criteria, and 85 full-text articles involving 29,217 patient samples were evaluated. A descriptive analysis is provided. Most studies were of poor quality (RCTs: 50%; Cohorts: 71%; Systematic Reviews/Meta-analyses: 66%; Cases: 67%). Case studies were fair (67%) to good (33%) quality. The level of certainty of the evidence was moderate for device-related, non-anticoagulant drugs, underlying conditions, and risk factor effects. A high level of evidence certainty was established for anticoagulant drugs, clinical outcomes (mortality/survival, bleeding risk, and filter life), and management and prevention. The subset analysis revealed small to large effect sizes for 19 parameters.

While platelet reductions exceeding 40% are associated with increased morbidity, the impact of CKRT on thrombocytopenia was reversible following treatment cessation in many patients.

This systematic review is the first to conclude that CKRT-induced thrombocytopenia appears reversible and may not be clinically significant unless affected by additional risk factors, including medications and existing comorbid conditions.