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Kidney Week

Abstract: PO0073

Plasma Metabolites Do Not Change Significantly After 48 Hours in Patients on CRRT

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Griffin, Benjamin R., University of Iowa, Iowa City, Iowa, United States
  • Ray, Matthew, University of Colorado, Denver, Colorado, United States
  • Rolloff, Kristy, University of Colorado, Denver, Colorado, United States
  • Brinton, John T., University of Colorado, Denver, Colorado, United States
  • Neyra, Javier A., University of Kentucky, Lexington, Kentucky, United States
  • Teixeira, J Pedro, University of New Mexico, Albuquerque, New Mexico, United States
  • Mayer, Kirby, University of Kentucky, Lexington, Kentucky, United States
  • Gist, Katja M., University of Colorado, Denver, Colorado, United States
  • Aftab, Muhammad, University of Colorado, Denver, Colorado, United States
  • Jalal, Diana I., University of Iowa, Iowa City, Iowa, United States
  • Haines, Julie, University of Colorado, Denver, Colorado, United States
  • Faubel, Sarah, University of Colorado, Denver, Colorado, United States
Background

Continuous renal replacement therapy (CRRT) is used in critically ill patients with hemodynamic instability. One of the primary aims of CRRT is to remove solutes that accumulate due to impaired kidney function. Surprisingly, few studies have assessed plasma solute levels during CRRT, and the duration of CRRT necessary to achieve adequate solute removal is unknown.

Methods

To assess the effect of CRRT on plasma solutes, metabolites were determined via untargeted ultra-high pressure liquid chromatography coupled to mass spectrometry (UHPLC-MS) in 13 critically ill patients requiring CRRT. Metabolites were assessed on plasma collected prior to CRRT initiation, and on plasma and effluent collected on days 1, 2, and 3 thereafter.

Results

A total of 101 annotated metabolites were evaluated. Plasma levels of 22 metabolites (21.8%) were significantly reduced by Day 1 of CRRT, and included creatinine, phosphate, lactate, and the amino acids alanine, proline, and cysteine. Only 2 metabolites (2.0%) were significantly reduced between Day 1 and Day 2, and none were reduced between Day 2 and Day 3. Figure 1 demonstrates that marginal changes in solute levels decrease as CRRT progresses. All metabolites were detected in the effluent, and the sieving coefficients for metabolites that were reduced versus not reduced after CRRT were not statistically different.

Conclusion

No further reduction in plasma metabolites occurred after 48 hours of CRRT. Since the median CRRT treatment time is 4-7 days nationwide, with some patients treated substantially longer, these data bring into question the utility of prolonged, uninterrupted CRRT therapy, and have major potential implications for the duration of CRRT in the ICU population.