Association of Phosphate Containing Solutions with Incident Hypophosphatemia in Critically Ill Patients Requiring Continuous Renal Replacement Therapy

2021 ◽  
pp. 1-8
Author(s):  
Melissa L. Thompson Bastin ◽  
Paul M. Adams ◽  
Sethabhisha Nerusu ◽  
Peter E. Morris ◽  
Kirby P. Mayer ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Medical Center ◽  
Academic Medical Center ◽  
Fold Increase ◽  
Academic Medical ◽  
Phosphate Supplementation

<b><i>Background:</i></b> Hypophosphatemia in critically ill patients is a common electrolyte disturbance associated with a myriad of adverse effects. Critically ill patients requiring continuous renal replacement therapy (CRRT) are at high risk of hypophosphatemia and often require phosphate supplementation during therapy. The aim of this study was to evaluate the association of phosphate versus non-phosphate containing CRRT solutions with incident hypophosphatemia in critically ill patients requiring CRRT. <b><i>Materials and Methods:</i></b> This is a single-center, retrospective, cohort study at a tertiary academic medical center of 1,396 adult patients requiring CRRT during their intensive care unit stay comprising 7,529 (phosphate containing) and 4,821 (non-phosphate containing) cumulative days of CRRT. Multivariable logistic regression was used to model the primary outcome of hypophosphatemia during CRRT according to exposure to phosphate versus non-phosphate containing CRRT solutions. <b><i>Results:</i></b> Incident hypophosphatemia during CRRT, serum phosphate &#x3c;2.5 mg/dL or 0.81 mmol/L, was significantly higher in the non-phosphate versus phosphate containing solution group: 304/489 (62%) versus 175/853 (21%) (<i>p</i> &#x3c; 0.001). Cumulative phosphate supplementation was also significantly higher in the non-phosphate versus phosphate containing solution group: 79 (IQR: 0–320) versus 0 (0–16) mmol (<i>p</i> &#x3c; 0.001). Non-phosphate solutions were associated with an 8-fold increase in the incidence of hypophosphatemia (adjusted OR 8.05; 95% CI 5.77, 11.26; <i>p</i> &#x3c; 0.001). <b><i>Discussion/Conclusions:</i></b> The use of phosphate containing CRRT solutions was independently associated with reduced risk of incident hypophosphatemia and decreased phosphate supplementation during CRRT. Interventional studies to confirm these findings are needed.

scholarly journals Factors Associated with Early Mortality in Critically Ill Patients Following the Initiation of Continuous Renal Replacement Therapy

2018 ◽  
Vol 7 (10) ◽  
pp. 334 ◽  
Author(s):  
Youn Kee ◽  
Dahye Kim ◽  
Seung-Jung Kim ◽  
Duk-Hee Kang ◽  
Kyu Choi ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Active Treatment ◽  
Critically Ill Patients ◽  
Medical Center ◽  
Academic Medical Center ◽  
Early Mortality ◽  
Factors Associated

Continuous renal replacement therapy (CRRT) is an important modality to support critically ill patients, and the need for CRRT treatment has been increasing. However, CRRT management is costly, and the associated resources are limited. Thus, it remains challenging to identify patients that are likely to have a poor outcome, despite active treatment with CRRT. We sought to elucidate the factors associated with early mortality after CRRT initiation. We analyzed 240 patients who initiated CRRT at an academic medical center between September 2016 and January 2018. We compared baseline characteristics between patients who died within seven days of initiating CRRT (early mortality), and those that survived more than seven days beyond the initiation of CRRT. Of the patients assessed, 130 (54.2%) died within seven days of CRRT initiation. Multivariate logistic regression models revealed that low mean arterial pressure, low arterial pH, and high Sequential Organ Failure Assessment score before CRRT initiation were significantly associated with increased early mortality in patients requiring CRRT. In conclusion, the mortality within seven days following CRRT initiation was very high in this study. We identified several factors that are associated with early mortality in patients undergoing CRRT, which may be useful in predicting early outcomes, despite active treatment with CRRT.

scholarly journals Vancomycin therapy in critically ill patients on continuous renal replacement therapy; are we doing enough?

2015 ◽  
Vol 23 (3) ◽  
pp. 327-329 ◽  
Author(s):  
Ali S. Omrani ◽  
Alaa Mously ◽  
Marylie P. Cabaluna ◽  
John Kawas ◽  
Mohammed M. Albarrak ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Vancomycin Therapy

scholarly journals Pragmatic Disease-Focused Checklist for Use During Rounding on Critically Ill Patients With COVID-19

2021 ◽  
pp. e1-e5
Author(s):  
Somnath Bose ◽  
Akiva Leibowitz
Keyword(s):  
Critically Ill ◽  
Family Communication ◽  
Critically Ill Patients ◽  
Inflammatory Markers ◽  
Medical Center ◽  
Academic Medical Center ◽  
Academic Medical ◽  
Ventilation Strategies ◽  
Novel Coronavirus ◽  
Existing Structure

The sudden surge in cases of novel coronavirus disease 2019 (COVID-19) has presented unprecedented challenges in the care of critically ill patients with the disease. A disease-focused checklist was developed to supplement and streamline the existing structure of rounds during a time of significant resource constraint. A total of 51 critical care consultants across multiple specialties at a tertiary academic medical center were surveyed regarding their preference for a structured checklist. Among the respondents, 82% were in favor of a disease-focused checklist. Mechanical ventilation parameters, rescue ventilation strategies, sedation regimens, inflammatory markers specific to COVID-19, and family communication were the elements most commonly identified as being important for inclusion in such a checklist.

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