When renal function is lost following resection of renal tumors, in the setting of end-stage kidney disease, or after traumatic nephrectomy, kidney transplantation is typically required; however, owing to constraints in healthcare resources, only a minority of patients can access transplantation. In this context, the development of efficient artificial kidneys as alternative therapies may help alleviate donor scarcity and holds potential clinical applicability, underscoring the substantial significance of this research. In the present study, a bibliometric analysis was conducted on the global literature in the field of artificial kidneys from 2014 to 2024, delineating overall developmental trends and technological hotspots. The findings indicate a marked increase in publications related to artificial kidneys over the past decade, with the field evolving from conventional renal replacement therapies toward a multidisciplinary paradigm integrating medicine, engineering, and artificial intelligence. The United States and other countries have made prominent contributions, and collaboration among multiple institutions has become increasingly frequent. Key research hotspots include the use of artificial intelligence in kidney-disease prediction models and clinical decision support, the development of implantable or wearable fully functional artificial kidneys, and advances in bioartificial kidneys and tissue-engineering technologies. The results further suggest that artificial-kidney technologies are entering a new stage characterized by increasing intelligence and convergence with biological and tissue-engineering approaches. Progress in novel immunomodulatory materials and biosensing technologies is expected to facilitate the development of artificial kidneys with therapeutic efficacy approaching that of kidney transplantation. This analysis provides an important reference for researchers, may help guide future research directions and promote cross-disciplinary collaboration, and ultimately may accelerate the realization of an ideal artificial kidney and improve the prognosis of patients with end-stage kidney disease.
Pre-dilution on-line hemodiafiltration (HDF) is a blood purification therapy where solute removal is performed by both diffusion and convection, influenced by operational parameters. This study aimed to investigate the effects of ultrafiltration rate (QF) or alternately the substitution fluid flow rate (QS) and the membrane surface area of a diafilter on solute removal efficiency for solutes of varying molecular weights, using both experimental and theoretical analysis, and to clarify the mechanism of solute removal in this treatment. Experiments were conducted with three diafilters of different membrane surface areas (1.1, 1.5, and 3.0 m2) in aqueous and bovine blood systems, varying QF (=QS) from 0 to 400 mL/min. The parameters required for the theoretical calculation were determined by experiments. In aqueous system, clearances for three solutes (creatinine, vitamin B12, and inulin) obtained by the theoretical calculations corresponded well with the theoretical calculations, showing how the solute removal was depending on the diffusion and convection. In blood system, however, membrane fouling significantly impacted solute clearances, particularly in diafilters with smaller membrane surface areas or higher QF (=QS), leading to deviations between experimental and theoretical values. This study clarified the correlation between solute clearance and QF (=QS) with varying membrane surface area in pre-dilution on-line HDF and showed the importance of considering the effects of fouling on numerical models for enhanced clinical applicability.
One goal of therapeutic efforts in sepsis/septic shock is rapid shock reversal that might be enhanced by adjunctive hemoadsorption by CytoSorb®. We hypothesized that shortening the time the adsorbers are used, reduces the time to shock reversal. In a retrospective study, we compared two groups of 16 and 17 patients with sepsis/septic shock treated with short change interval (sci) of 14.2 (12.9, 15.2) h/adsorber or long change interval (lci) of 21.7 (17.6, 24.0) h/adsorber. Time to shock reversal, defined as the time from hemoadsorption start to the end of norepinephrine treatment, was similar between groups (sci: 5 (3.8, 12.7), lci: 10.8 (6.5, 18.5) days; p = 0.210) and did not correlate with the change interval. At baseline, the change interval correlated inversely with interleukin-6 (IL-6; p < 0.001). From baseline to day 5 the significant decrease of thrombocytes was more pronounced in the sci group. Shortening the CytoSorb® change interval did not promote faster shock reversal, but imbalances in baseline imply patients in the sci group to have been sicker. Hemodynamic instability and high IL-6 levels prompted intensivists to use shorter change intervals. Possibly the increased number of adsorber binding sites was too low to be effective, or the observed spread between the short and lci was ineffective, or shortening of the change interval improved the outcomes of patients with higher risk profiles at baseline. The calculation of an effective hemoadsorption dose, be it by the amount of blood purified, or binding sites, or a combination hereof, remains speculative. Not applicable.
Perforation on tympanic membrane could decrease the hearing ability. In some cases, myringoplasty should be performed. Myringoplasty requires material as patch to cover tympanic membrane's hole. This study is aimed to create innovation based on chitosan-collagen with glycerol plasticizers as scaffold patch for tympanic membrane perforation. The sample preparation method included mixing various concentrations of chitosan-collagen with the ratio of 1:0; 9:1; 8:2; 7:3 and 0.5 ml of glycerol for each sample variation. The characterization included FTIR test, morphological test, sound transmission class test, tensile strength test, degradation test, swelling test, and antibacterial test. The functional group test showed that in the sample variations 9:1; 8:2; 7:3 there was an absorption at the wave number 2347 cm-1 which showed deformation of the NH group. Morphological analysis showed that as the collagen concentration increased, the microstructure exhibited more pronounced fine wrinkles. The sound transmission class test showed all sample variations did not reduce the sound so the scaffold patch transmitted sound properly. Tensile strength test showed the sample with the variation of 8:2 had the greatest strength value (8.02 MPa) but still below the value of tympanic membrane tensile strength ±20 MPa. The degradation test showed the samples were able to survive during the tympanic membrane healing process for approximately one until 2 months. The optimization of plasticizer amount need to be adjusted in order to increase tensile strength. The presence of free hydrophilic groups (group COOH, NH2, and -OH) cause the sample to have hydrophilic properties so that it is easily degraded and undergoes swelling. In antibacterial assay, the inhibition zone was not formed because chitosan could not diffuse through the agar.
This case describes an 82-year-old male patient presenting with persistent upper abdominal colic, diagnosed as severe acute pancreatitis. The patient then suffered a cytokine storm, as well as renal dysfunction. Therefore, the patient underwent two sessions of coupled plasma filtration adsorption (CPFA) therapy utilising the CA330 cytokine adsorption cartridge as the adsorbent. The first CPFA session lasted 8 h, followed by a 4-h interval (during which continuous veno-venous haemodialysis therapy was provided), and the second 8-h CPFA session started. Due to family requests and comprehensive consideration by the medical team, the second CPFA session was extended to 20 h. Ultimately, the patient was weaned off blood purification therapy (43 h after its initiation). The study demonstrated a significant reduction in cytokine levels as the course of treatment increased. However, beyond a specific threshold, cytokine adsorption may reach saturation. The medicinal applications of CPFA (particularly CA330) deserve more investigation.
Liver dysfunction is a common phenomenon in critically ill patients. Extracorporeal albumin dialysis (ECAD) is established in supporting liver function as a bridge to transplant or recovery. ECAD device OPAL is confirmed in clinical routine and studied in terms of detoxification capabilities, efficacy and efficiency. For the ECAD device ALBUNIQUE, a further developed system requiring less specialised technical equipment, no corresponding literature is available. This retrospective single-center study included patients undergoing ECAD, either OPAL and/or ALBUNIQUE, in a two-year period from 2023 to 2024, with treatment times of 12 h or more. Generalized Estimating Equations were used to compare the effects of ECAD therapy. In total, n = 25 patients with ECAD treatments were identified in our institution. Among these patients n = 90 ECAD cycles were eligible for evaluation, thereof n = 58 (64%) treatments with OPAL and n = 32 (36%) with ALBUNIQUE. ECAD treatment resulted in significant reduction of bilirubin, ammonia, creatinine, and urea levels as well as significant increase of negative base excess values. The first ECAD cycle was associated with highest percental changes. There were no significant differences between the parameters gathered by OPAL and ALBUNIQUE. Both ECAD systems, OPAL and ALBUNIQUE, were effective in removing bilirubin, reducing ammonia levels, eliminating water-soluble substances and stabilizing metabolic dysfunction without significant differences between the devices. Further, we found no increased bleeding risk during or after application of ECAD treatment in general or for one of the examined devices.
As a surgical treatment option for heart failure, left ventricular assist devices (LVAD) help to restore function in failing hearts. Recent studies suggest possible negative impacts of this therapy, as LVAD reduces blood flow and allows potential for coronary remodeling and increased intimal alteration. Our study examined patients with clinically diagnosed non-ischemic cardiomyopathy (NICM) and subsequent heart failure necessitating transplantation and the use of LVAD as a bridge to transplant. Surgically explanted heart specimens were identified and both semi-quantitatively scored and quantitatively assessed for the degree of cross-sectional coronary artery luminal narrowing. Non-parametric statistical analysis of semi-quantitative scored cases was conducted to examine differences between the test population and a control population of NICM patients undergoing transplant without the use of LVAD bridge to therapy. Parametric analysis of the quantitative digitally assessed cases was conducted to corroborate these results. The test population demonstrated a statistically significant difference in coronary artery luminal narrowing compared to the control population. Our findings suggest increased coronary artery disease in previous NICM patients receiving LVAD as a bridge to transplantation regardless of the time with the implanted device. Further work is necessary for future correlation, as these findings bear importance for improving transplant patient outcomes.
This cohort study compared split-thickness skin graft transplantation and dispersed implantation of autologous strip skin (ASS) grafts combined with small autologous columnar skin (SCS) grafts for the treatment of small-area deep burn wounds. The experimental group was treated with dispersed implantation of ASS grafts combined with SCS grafts, whereas the control group underwent split-thickness skin graft (STSG) transplantation. The graft survival rate was significantly greater in the experimental group (p < 0.0001). The time to complete epithelialization was similar for both groups (p = 0.6626). The ratio of the donor site area to the wound area was lower (p = 0.0002), and the healing time for the donor site was shorter in the experimental group (p < 0.0001). Additionally, the Vancouver Scar Scale (VSS) scores for both the donor and recipient sites were significantly lower in the experimental group (p < 0.0001, p = 0.0075). The combined implantation of ASS and SCS grafts effectively promoted the healing of small-area third-degree burn wounds, with good preservation of hair follicles and sebaceous glands. This method reduces wound contraction and damage to the donor site, with no significant lamellate scar hyperplasia observed during long-term follow-up, making it a viable alternative to split-thickness skin graft transplantation.
Postcardiotomy shock is a condition characterized by a very high mortality rate in patients with low output following cardiac surgery. Providing mechanical circulatory support using an intra-aortic balloon pump (IABP) is one treatment option for this condition. IABP is known to have a positive hemodynamic effect on some organs. However, significant hemodynamic studies on end-organs are not yet available in the literature. This retrospective study included 75 patients who underwent coronary artery bypass grafting (IABP) at the Cardiovascular Surgery Clinic of Konya City Hospital between December 2020 and July 2025 and underwent postcardiotomy shock. Patients were divided into two groups based on IABP location. Laboratory findings were used to analyze the hemodynamic effects of IABP location on end organs and the heart. No statistically significant differences were observed between the IABP placement site and age, BMI, duration of IABP use, or any preoperative and postoperative laboratory parameters. While the preoperative AST/ALT ratio did not differ significantly between the two groups, the postoperative AST/ALT ratio was found to be significantly higher in the supradiaphragmatic IABP placement group compared with the infradiaphragmatic IABP placement group. The IABP is one of the mechanical support devices used to manage postcardiotomy shock after coronary bypass surgery. Although it is used for its beneficial effects on cardiac hemodynamics, it can also cause changes in visceral organs in some cases.
High shear rate and non-physiological turbulent flow caused by bileaflet mechanical heart valves (BMHVs) lead to platelet activation and adhesion, which can cause rapid thrombus growth and severe consequences. This study employed computational modeling to analyze the effect of surface texture on flow field around the BMHVs. The textures' positional, geometric, and dimensional parameters were optimized based on flow field analysis. The textured BMHVs were then implanted in sheep for 6 months, with pyrolytic carbon BMHVs serving as the control group. The textured BMHVs significantly reduced high-velocity, low-velocity, high turbulent shear stress, and high shear rate regions in the flow field. Post-implantation, the experimental groups with textured BMHVs exhibited lower levels of platelet activation and neither the intrinsic nor extrinsic coagulation cascade reactions were activated in the sheep. Detailed observations revealed an absence of erythrocyte or platelet adhesion within the grooved texture regions, with minimal adhesion at the peripheral edges of the textured areas. The optimized surface textures on BMHVs effectively reduce adverse flow conditions and platelet activation, potentially decreasing the need for anticoagulant therapy and minimizing the associated bleeding risks. These findings are crucial for enhancing the long-term safety and efficacy of BMHV implantation.
Type 1 diabetes (T1D) management remains particularly challenging in the presence of external disturbances such as stress or physical activity (PA). The glycemic impact of PA is still not fully understood and lacks standardized modeling approaches. This work seeks to describe the relationship between PA, time-in-range and glucose predictability in people with T1D (PwT1D). This study uses data from the Type 1 Diabetes and Exercise Initiative (T1DEXI) clinical trial, the largest trial to date in PwT1D undergoing both free-living and structured exercise. A characterization pipeline extracts summary statistics including glucose, carbohydrate intake and PA signals. These features are used to perform unsupervised clustering of subjects using various techniques. The relevance of the cluster-defining variables is then assessed, and their relationship to the performance of a long short-term memory (LSTM) neural network trained to forecast glucose 1 h into the future is analyzed. The spectral clustering algorithm successfully separates individuals into three groups based on glycemic control metrics. Results indicate that subjects with higher levels of weekly PA exhibit lower prediction errors. This suggests that regular PA enhances the predictability of glucose trends, enabling more accurate forecasting models. Since fear of hypoglycemia remains one of the main barriers to PA in PwT1D, these findings are particularly relevant: regular exercise not only promotes better glycemic regulation but also improves the performance of predictive models, which could strengthen automated insulin delivery systems, support more reliable decision-support tools and contribute to safer and more confident engagement in PA.
The conventional triple immunosuppressive regimen administered following heart transplantation typically comprises a calcineurin inhibitor, an antiproliferative agent, and corticosteroids. Everolimus has emerged as a viable alternative to calcineurin inhibitors. This study aims to evaluate the immunosuppressive efficacy and adverse effect profile of everolimus when introduced after the first post-transplant year, in comparison to continued calcineurin inhibitor therapy. A retrospective analysis was conducted on 90 heart transplant recipients under regular follow up. Patients were categorized into two groups: those who maintained calcineurin inhibitor therapy beyond the first year post-transplant (n = 45), and those who transitioned to everolimus after the first year (n = 45). The groups were compared in terms of rejection incidence and side effects. Following the treatment modification, the everolimus group showed a significant improvement in serum urea and creatinine levels (p < 0.05). Rejection rates after the first year were found to be similar between the two groups. Everolimus provides effective immunosuppression with a lower rate of side effects.It demonstrates a favorable impact on renal function without increasing the risk of rejection.The first year may be recommended as the optimal timing, considering both safe wound healing and the risk of rejection.
Enhancing information security via reliable user authentication in wireless body area network (WBAN)-based Internet of Things (IoT) applications has garnered increasing attention. Traditional biometric methods, like fingerprint recognition, carry significant privacy risks because they cannot be cancelled or changed. Once a biometric template is exposed, it cannot be replaced, leading to potential privacy violations. Addressing these challenges, this study proposes a novel Secure EMG Framework, a cancellable biometric modality using surface electromyogram (sEMG) signals encoded by hand gesture passwords for user authentication. sEMG signals are collected from the forearm muscles, specifically the flexor carpi ulnaris (FCU), during hand gestures, forming a unique and secure biometric token. This proposed method enhances security and reliability through a multi-stage process that involves data capture, pre-processing, feature extraction, and machine learning-based computation of matching scores. A cancellable biometric token is generated through the collection of sEMG data during 16 static wrist and hand movements, increasing authentication diversity and security. To ensure signal clarity within the critical frequency range of 5-500 Hz, a Pure Frequency Hamming Filter is used to reduce noise and artifacts in the raw sEMG data. Key time-domain parameters are then extracted to form a 16-length feature vector, enhancing gesture discrimination. To further improve classification accuracy, a Tuned Boost Perfect Classifier is implemented, addressing overfitting and minimizing errors. The matching score computation enables the evaluation of input and registered signal similarity, allowing users to reset compromised biometric tokens. Experimental results validate the method, achieving an accuracy of 99.72%, an F1-score of 96.0%, and an Equal Error Rate (EER) of 0.0037.
Progress of breakthrough Roll Porous Scaffold (RPS) 3D Bioprinting technology with great potential for personalized medicine, targeted therapy and overcoming the shortage of organs for implantation achieves first physical confirmation. The efficiency of RPS for the formation of solid organoid can exceed liters per hour with ~10-35 µm cells in 5, 18, and 84 pL drops due to significantly increased print exposure for cell filtration and based on the lines of many usual Kyocera inkjet printheads "KJ4B-1200," "KJ4C-0360," and "KJ4A-0300, KJ4B-0300" with resolution of 1200, 360, and 300 DPI accordingly. Films samples were made and a method was developed to control the formation of an object inside a roll not by one, but by two parameters. After laser perforation of these ribbons with 1200 DPI precision, holes size of ~60-120 µm and boundaries of ~20-45 µm respectively, the MTT (methylthiazolyl tetrazolium) assay with 8 replicates for each experimental group according to GOST ISO 10993-5:2023 showed good cell viability of >78%-97%. An additional parameter for formatting the reinforcing tape from a durable incompressible material, which determines the thickness of the wind layer, allows taking into account its uneven height when forming a 3D model of the organoid.
This study aims to evaluate the clinical and demographic factors influencing the restoration of sinus rhythm and postoperative outcomes in patients undergoing bipolar radiofrequency ablation (RFA) concomitant with mitral valve surgery. By analyzing the associations between rhythm outcomes, mortality, and patient characteristics, this study seeks to identify predictors of ablation success and provide valuable insights into optimizing treatment strategies for atrial fibrillation in this high-risk patient population. Demographic and clinical characteristics of the patients were analyzed. Postoperative electrocardiography (ECG) findings during the first year after surgery were used to classify patients into two groups: those who achieved sinus rhythm (SR) and those who remained in atrial fibrillation (AF). Additionally, patients were categorized into survivors and non-survivors within the first postoperative year for statistical comparisons. The overall rate of sinus rhythm (SR) restoration within the first year after radiofrequency (RF) ablation was 70.2% (n = 85). When comparing patients who achieved SR with those who remained in atrial fibrillation (AF) postoperatively, the AF group exhibited significantly larger preoperative ascending aortic diameters, left atrial diameters, and interventricular septal thicknesses, along with lower ejection fractions on transthoracic echocardiography (TTE) (p = <0.001, 0.015, 0.012, and 0.024, respectively). Radiofrequency ablation is a safe and effective method for maintaining long-term sinus rhythm, with no additional complications. It is associated with a low risk of morbidity and thromboembolic complications.
Blood-handling devices are commonly used for blood transportation or regulation, but their specialized flow channel geometries tend to create high-shear-stress flow regimes, which may induce excessive cellular damage risks and energy dissipation. To address this, this study combines computational fluid dynamics and particle image velocimetry experimental methods to establish nozzle reference models with multiple orifice diameter configurations. Based on entropy generation theory and Ω vortex identification methods, the underlying energy dissipation mechanisms and vortex dynamics under distinct high-shear-stress conditions are analyzed. The results indicate that shear flow intensity is highly correlated with energy dissipation due to entropy production. Attenuating turbulence in the flow field simultaneously suppresses shear stress damage and energy loss, while lowering shear flow intensity promotes the decomposition of vortices downstream, broadening their spatial distribution. High flow velocity alone does not directly induce shear stress or entropy-related energy dissipation; rather, an excessively steep velocity gradient is the primary factor affecting flow field safety and efficiency. A 94% rise in velocity gradient results in average increases of 97.6% in shear stress and 99.6% in energy entropy production. During flow regime transition or under pronounced velocity gradients, shear-dominated vortices readily form and generate vortex-like energy dissipation during evolution, which is a key factor exacerbating energy loss in high-shear-stress flow fields. This study elucidates the energy dissipation mechanisms and vortex dynamics in high-shear-stress flow fields of blood-handling devices, providing theoretical and technical support for optimizing flow fields and performance in relevant devices.
Sepsis is a life-threatening condition characterized by organ dysfunction due to a dysregulated host response to infection. Septic shock, a severe form of sepsis, involves hypotension requiring vasopressor support and elevated lactate levels, leading to tissue hypoperfusion. Beyond standard therapy, various extracorporeal blood purification techniques have been developed to remove infectious agents and inflammatory mediators produced by the dysregulated immune response. This multicenter, retrospective observational cohort study analyzed medical records of patients hospitalized between 2021 and 2024. Patients with comparable admission timing and baseline SOFA and APACHE II scores were divided into two groups: Group 1 (no adsorptive therapy) and Group 2 (adsorptive therapy). Baseline and follow-up SOFA scores, vital signs, laboratory parameters, and culture results on days 1, 3, 5, and 10 were recorded. The overall mortality rate was 73.5% (275 ex). Crude mortality was 74.3% (139/187) in the no-filter group and 72.7% (136/187) in the filter group, with no significant difference observed (p = 0.815). Across all analytical approaches, no analysis reached statistical significance at the 0.05 level, with p-values ranging from 0.081 to 0.815. CRP, procalcitonin, and lactate levels showed a decreasing trend in both groups during treatment, with no significant differences between groups (p = 0.168, 0.322, and 0.649). Mortality did not differ significantly between early (within first 24 h) and late (>24 h) filter application groups (HR p = 0.91, p = 0.62). In patients with septic shock, filters used for extracorporeal blood purification reduce the levels of inflammatory mediators. However, no effect on mortality reduction was observed.
Cholic acid (CA) and indoxyl sulfate (IS) are toxins associated with biliary and renal disease. Protein binding prevents removal by traditional dialysis. Dissolving binding molecules such as albumin in dialysate enables detoxification. We created a benchtop albumin dialysis test platform. We used it to validate a mathematical model of CA/IS removal. Toxin-containing blood analog solution was dialyzed using two dialyzers at five flow rates against albumin dialysate. One condition was used to estimate toxin binding affinity to albumin and the free toxin transmembrane transfer coefficient (KfreeA). Other conditions validated modeling results and revealed the impact of dialysate flow rate and dialyzer properties on detoxification (measured by mass spectrometry). We accurately predicted CA/IS removal. The normalized root mean squared error never exceeds 11.5% of the starting amount. Increasing dialysate side flow rate up to 150 mL/min improved toxin removal. Further increases produced no benefit. KfreeA was independent of flow rate. Our data fits a result from the newly developed AMOR system, in which total bile acids declined with treatment. This model and benchtop setup aim to predict clinical CA/IS clearance and optimize device design for clinical trials. This will mean fewer unsuccessful trials and enable testing of new dialysate formulations.
This study aimed to evaluate the impact of sarcopenia and frailty on the quality of life of older hemodialysis patients. Seventy hemodialysis patients aged ⩾60 years were assessed. Daily living activities (Katz Index), depression (Yesavage Scale), frailty (Fried's Criteria), and sarcopenia (EWGSOP2) were evaluated. Quality of life was measured using the KDQOL-36 questionnaire. The median age was 67 years, and 50% were female. Nineteen patients (27.1%) were partially dependent, 71.4% were pre-frail, and 15.7% were frail. Probable sarcopenia was detected in 77.1%, and sarcopenia in 8.6% of patients. Sarcopenia was associated with older age, higher dependency, depression, lower income, and frailty (p < 0.05). It was also related to the KDQOL-36 physical component (p = 0.031), while frailty correlated with the symptom component (p = 0.047). Frailty and sarcopenia are common in older hemodialysis patients and adversely affect their quality of life.
Continuous renal replacement therapy (CRRT) plays a crucial role in the management of acute kidney injury (AKI) and fluid overload among critically ill patients. Despite its clinical significance, comprehensive real-world evidence from the Chinese population regarding the clinical application of CRRT, including anticoagulation strategies and factors influencing therapeutic efficacy, remains scarce. This retrospective cohort study was performed to examine all CRRT treatments administered in the ICU of a tertiary Grade A hospital from July 1 to August 31, 2025. A total of 238 CRRT sessions fulfilling the inclusion criteria were analyzed. Data collected encompassed patient demographics, illness severity scores (APACHE II and SOFA), CRRT treatment parameters, anticoagulation strategies, laboratory indicators, and causes leading to treatment discontinuation. The primary outcome comprised filter survival time, which was analyzed using Kaplan-Meier analysis and Cox proportional hazards models. The analysis included 238 sessions derived from 187 patients (median age 67; 61.3% male). CVVH was the most commonly applied modality (55.9%). Meanwhile, citrate anticoagulation was employed in 49.6% of sessions, followed by heparin (28.2%). The predominant reason for discontinuation was filter clotting (33.6%). Multivariable analysis revealed that the use of citrate anticoagulation was associated with a significantly reduced risk of filter clotting compared to heparin (HR = 0.49, 95% CI 0.29-0.81, p = 0.006). Likewise, a blood flow rate exceeding 150 mL/min was associated with a protective effect (HR = 0.65, 95% CI 0.43-0.98, p = 0.039), whereas mechanical ventilation was associated with an increased risk of filter clotting (HR = 2.15, 95% CI 1.16-3.99, p = 0.015). Finally, median filter survival was 38.5 h for citrate, 18.0 h for heparin, and 26.0 h for nafamostat (log-rank p < 0.001). This real-world study demonstrates a strong association between citrate anticoagulation and extended filter lifespan during CRRT, supporting its role as the preferred anticoagulation approach in this setting. Moreover, maintaining adequate blood flow rates and adopting customized anticoagulation management for mechanically ventilated patients may further enhance CRRT efficacy. These findings collectively provide valuable real-world evidence to inform clinical decision-making.