Abstract: FR-PO048
Effects of a Novel CRRT Fluid Protocol on Electrolyte Stability
Session Information
- AKI: Clinical Outcomes, Trials
November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Boo, Hyo jin, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Gangnam, Korea (the Republic of)
- Baeg, Song in, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Gangnam, Korea (the Republic of)
- Lee, Kyungho, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Gangnam, Korea (the Republic of)
- Park, Kyungho, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Gangnam, Korea (the Republic of)
- Lee, Jung eun, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Gangnam, Korea (the Republic of)
- Huh, Wooseong, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Gangnam, Korea (the Republic of)
- Kim, Yoon-Goo, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Gangnam, Korea (the Republic of)
- Kim, Dae joong, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Gangnam, Korea (the Republic of)
- Jang, Hye Ryoun, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Gangnam, Korea (the Republic of)
Background
Continuous renal replacement therapy (CRRT) is the standard treatment for critically ill patients with acute kidney injury. During CRRT, electrolyte disturbance such as hypokalemia or hypophosphatemia frequently occurs unless dialysate and replacement solutions are adequately adjusted. Samsung Medical Center CRRT team developed a new protocol to prevent electrolyte disturbance by adjusting dialysate and replacement fluids depending on serial changes in serum potassium and phosphorus levels. We evaluated the impact of the new CRRT fluid protocol on electrolyte stability.
Methods
Adult patients who received CRRT for 3 days or more during the previous two years (2013 to 2014; pre-protocol group) and the last two years (2016 to 2017; protocol group) following the development of the fluid protocol were compared. Individual coefficient of variation (CV) and the number of abnormal measurements for electrolytes during CRRT were analyzed. The frequency of potassium, phosphorus, or magnesium replacement therapy was also compared. The Wilcoxon rank sum test was used for analysis.
Results
A total of 1456 patients were included. There were no significant differences in age, gender, and CRRT duration between the two groups. The CV of serum potassium was lower in the protocol group (pre-protocol group vs. protocol group, 0.113 [0.066 - 0.160] vs. 0.092 [0.052 - 0.132], p<0.0001). The CV of serum phosphorus was also lower in the protocol group (pre-protocol group vs. protocol group, 0.292 [0.173 - 0.411] vs. 0.248 [0.140 - 0.356], p<0.0001). The event rates of abnormal potassium levels (pre-protocol group vs. protocol group, 0.205 [0.199 - 0.211] vs. 0.083 [0.079 - 0.087], p<0.0001) and abnormal phosphorus levels (pre-protocol group vs. protocol group, 0.406 [0.398 - 0.415] vs. 0.280 [0.273 - 0.286], p<0.0001) were lower in the protocol group. The CV of serum magnesium, sodium, and ionized calcium was also lower in the protocol group. The frequency of potassium, phosphorus, and magnesium replacement was significantly reduced after application of our new CRRT fluid protocol (p<0.001).
Conclusion
Our novel CRRT fluid protocol significantly increased electrolyte stability and consequently prevented electrolyte disturbance during CRRT.