Abstract: PO0697
Lower Continuous Venovenous Hemodialysis Replacement Rate and Its Effect on Patient Outcome in the COVID Crisis Time
Session Information
- COVID-19: AKI and Outcomes
October 22, 2020 | Location: On-Demand
Abstract Time: 10:00 AM - 12:00 PM
Category: Coronavirus (COVID-19)
- 000 Coronavirus (COVID-19)
Authors
- Guirguis, John Kimy Demian, Indiana University School of Medicine, Indianapolis, Indiana, United States
- Yenebere, Priya, Indiana University School of Medicine, Indianapolis, Indiana, United States
- Sher, S. Jawad, Indiana University School of Medicine, Indianapolis, Indiana, United States
- Kelly, Katherine J., Indiana University School of Medicine, Indianapolis, Indiana, United States
Background
Acute kidney injury (AKI) is a common problem encountered in COVID positive patients with incidence close to 23% and mortality close to 60% in this cohort of patients. Continuous Veno-Venous Hemodialysis (CVVH) plays a primary role in management of these patients. Nephrologists nationwide have been facing a compelling supply/demand mismatch dilemma. Lowering the rate of replacement fluid flow rate (RFFR) is one strategy that was used by our practice to mitigate this issue in selected patients. We hypothesize there is no difference in clinical outcome between the patients receiving high RFFR vs low RFFR.
Methods
This is a retrospective observational study from a single center experience. We analyzed data from March 2020 till the end of May 2020. We included patients with confirmed coronavirus disease 2019 (COVID-19) who required CVVH during their hospitalization. Patients were divided into two groups i.e Group 1 (> 20ml/kg/hr RFFR) vs Group 2 (< 20ml/kg/hr RFFR). Patients 18 years or older with at least 3 days of CVVH during their hospital stay were included. We compared percentage drop of blood urea nitrogen (BUN) and phosphorus as well as hospital stay and mortality between the 2 groups. We used ANOVA, t-test and Chi square for analysis, as appropriate.
Results
We enrolled 36 patients in the study, 20 in group 1 and 16 in group 2. Eighty percent of the patients enrolled were men. Mean weight was 100 ± 8kg in group 1 vs 107 ± 8 in group 2. There was no statistically significant difference in percentage reduction of blood urea nitrogen (BUN) or phosphorus (Po4) P= 0.2& 0.5 respectively (Means 25.4 vs 21.7 & 18.4 vs 17.1). Mean filtration fraction was similar between the two groups (17.9% vs 17%). Frequency of line clotting events was compared in the two groups using Chi square with P value 0.8. Mortality was not significantly different between groups, although it was actually lower in the groups treated with the lower RFFR.
Conclusion
Although our data analysis is still evolving, we found no difference in mortality, toxin clearance and frequency of line clotting between the two studied groups. No randomized control trial has assessed using a lower than 20ml/kg/hr RFFR in CVVH. Our study, thus far, showed no difference between the two groups. This finding needs to be further validated in a randomized control study.