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Abstract: TH-PO507

Phosphate-Containing vs. Phosphate-Free Solutions in Pediatric Continuous Renal Replacement Therapy: A WE-ROCK Study

Session Information

  • Pediatric Nephrology - I
    November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

  • 1900 Pediatric Nephrology

Authors

  • Zafar, Faizeen, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Gist, Katja M., Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Neyra, Javier A., The University of Alabama at Birmingham, Birmingham, Alabama, United States
  • Selewski, David T., Medical University of South Carolina, Charleston, South Carolina, United States
  • Zang, Huaiyu, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Ollberding, Nicholas J., Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Menon, Shina, Seattle Children's Hospital, Seattle, Washington, United States
Background

Hypophosphatemia is common in patients on continuous renal replacement therapy (CRRT), and is associated with adverse outcomes (prolonged mechanical ventilation (MV) and longer ICU stay). We aimed to compare outcomes between commercially available phosphate-containing (1 mmol/L, PHOS+) and phosphate-free (PHOS-) solutions in pediatric CRRT patients.

Methods

The Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease (WE-ROCK) is a 32-center registry of patients aged 0-25 years treated with CRRT for acute kidney injury or fluid overload (FO). This analysis excluded patients with incomplete CRRT fluid data or those receiving pharmacy-compounded solutions with variable phosphate concentrations. Primary outcomes were 28-day MV- and ICU-free days. Multivariable regression analyses were conducted for outcome comparisons.

Results

We included 410 patients; median age 8.2 years (IQR 1.6-14.1y). Of these, 43.4% (178/410) received PHOS+. The PHOS+ group had a higher %FO (7.2% vs. 5.4%, p=0.009) and lower MV rate at CRRT initiation (64% vs. 82%, p<0.001). There was no difference in PELOD and vasoactive inotropic score between the groups. Both groups received a similar dose of CRRT (42 vs 48 ml/kg/h, p=0.4) although the duration was longer for the PHOS+ group (7 vs 4d, p<0.001). The PHOS+ group had less incident hypophosphatemia (<2.5 mg/dl) during CRRT compared to the PHOS- group (20% vs. 33%, p=0.007). However, there were no differences in 28-day MV- and ICU-free days and 90-day mortality between the 2 groups in unadjusted and adjusted analyses (Table).

Conclusion

PHOS+ (1 mmol/L) CRRT solutions reduced incident hypophosphatemia in this pediatric cohort but did not associate with reduction in 90-day mortality or less ventilator or ICU resource utilization.

Multivariable analysis for 28-day ventilator- and ICU-free days