Abstract: SA-PO660

Thrombocytopenia among Critically Ill Patients Receiving CRRT in the Medical ICU: Is it AKI or CRRT?

Session Information

Category: Dialysis

  • 602 Dialysis for AKI: Hemodialysis, CRRT, SLED, Others

Authors

  • Bandak, Ghassan, Mayo Clinic, Rochester, Minnesota, United States
  • Sakhuja, Ankit, Mayo Clinic, Rochester, Minnesota, United States
  • Banaei-Kashani, Kianoush, Mayo Clinic, Rochester, Minnesota, United States
Background

Thrombocytopenia has been reported as a side effect of hemodialysis in ESRD patients. It has also been reported in critically ill patients receiving CRRT. CRRT is commonly used in patients requiring RRT who are hemodynamically unstable in the ICU for both patients with AKI and ESRD. However, these populations are different in multiple aspects. There are various patient and treatment-related factors that are proposed to be contributing to thrombocytopenia. Furthermore, thrombocytopenia has been linked to increased mortality among patients receiving CRRT. We hypothesized that the rates of thrombocytopenia will be higher among patients with AKI in comparison with ESRD patients given their severe inflammatory state, new exposure to extracorporeal membranes and uremic milieu.

Methods

We performed a retrospective analysis of all patients receiving CRRT in our institution between Jan 1, 2007, to Oct 31, 2015. Data was electronically abstracted from the electronic medical chart. We included patients in medical ICUs and excluded patients in surgical and cardiovascular ICUs. We identified ESRD patients using ICD 9 and 10 codes. New thrombocytopenia was defined as a 50% drop in platelets count after CRRT initiation. We performed a chi-square test to compare rates of decline in platelets among ESRD and AKI patients. A P-value of 0.05 was considered to be statistically significant. Data analysis was done using STATA 14.0. We provide a standard CVVH prescription with regional citrate anticoagulation for all patients in our ICUs

Results

We identified a total of 673 unique patients who received CRRT in medical ICUs. A total of 94 patients (13.9%) had a diagnosis of ESRD. 54.4% were males. Median (IQR) age was 60 years (51-68). The rate of new thrombocytopenia after CRRT initiation was 55.4%. Median platelet count prior to CRRT was 107 and median lowest platelet count after CRRT initiation was 45. The incidence of drop of platelets amongst patients with ESRD was 53.8% vs. 55.6% amongst those without ESRD (P=0.7)

Conclusion

Both ESRD patients and AKI patients requiring CRRT are at significant risk of developing thrombocytopenia. The risk is not different between the two patient populations and is possibly influenced by CRRT treatment-related factors in the setting of critical illness.