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Original ArticleAcute Kidney Injury and ICU Nephrology
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Association of Phosphate-Containing versus Phosphate-Free Solutions on Ventilator Days in Patients Requiring Continuous Kidney Replacement Therapy

Melissa L. Thompson Bastin, Arnold J. Stromberg, Sethabhisha N. Nerusu, Lucas J. Liu, Kirby P. Mayer, Kathleen D. Liu, Sean M. Bagshaw, Ron Wald, Peter E. Morris and Javier A. Neyra
CJASN May 2022, 17 (5) 634-642; DOI: https://doi.org/10.2215/CJN.12410921
Melissa L. Thompson Bastin
1Department of Pharmacy Services, University of Kentucky Medical Center, Lexington, Kentucky
2Department of Pharmacy Practice and Science, University of Kentucky, Lexington, Kentucky
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Arnold J. Stromberg
3Department of Statistics, University of Kentucky, Lexington, Kentucky
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Sethabhisha N. Nerusu
4Center for Health Services Research, University of Kentucky, Lexington, Kentucky
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Lucas J. Liu
5Department of Computer Science, University of Kentucky, Lexington, Kentucky
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Kirby P. Mayer
6Department of Physical Therapy, University of Kentucky, Lexington, Kentucky
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Kathleen D. Liu
7Division of Nephrology, Department of Medicine, University of California, San Francisco, California
8Division of Nephrology, Department of Anesthesia, University of California, San Francisco, California
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Sean M. Bagshaw
9Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, Edmonton, Alberta, Canada
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Ron Wald
10Division of Nephrology, St. Michael’s Hospital and the University of Toronto, Toronto, Ontario, Canada
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Peter E. Morris
11Division of Pulmonary, Critical Care and Sleep Medicine, University of Kentucky, Lexington, Kentucky
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Javier A. Neyra
12Department of Internal Medicine, Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky, Lexington, Kentucky
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Abstract

Background and objectives Hypophosphatemia is commonly observed in patients receiving continuous KRT. Patients who develop hypophosphatemia may be at risk of respiratory and neuromuscular dysfunction and therefore subject to prolongation of ventilator support. We evaluated the association of phosphate-containing versus phosphate-free continuous KRT solutions with ventilator dependence in critically ill patients receiving continuous KRT.

Design, setting, participants, & measurements Our study was a single-center, retrospective, pre-post cohort study of adult patients receiving continuous KRT and mechanical ventilation during their intensive care unit stay. Zero-inflated negative binomial regression with and without propensity score matching was used to model our primary outcome: ventilator-free days at 28 days. Intensive care unit and hospital lengths of stay as well as hospital mortality were analyzed with a t test or a chi-squared test, as appropriate.

Results We identified 992 eligible patients, of whom 649 (65%) received phosphate-containing solutions and 343 (35%) received phosphate-free solutions. In multivariable models, patients receiving phosphate-containing continuous KRT solutions had 12% (95% confidence interval, 0.17 to 0.47) more ventilator-free days at 28 days. Patients exposed to phosphate-containing versus phosphate-free solutions had 17% (95% confidence interval, −0.08 to −0.30) fewer days in the intensive care unit and 20% (95% confidence interval, − 0.12 to −0.32) fewer days in the hospital. Concordant results were observed for ventilator-free days at 28 days in the propensity score matched analysis. There was no difference in hospital mortality between the groups.

Conclusions The use of phosphate-containing versus phosphate-free continuous KRT solutions was independently associated with fewer ventilator days and shorter stay in the intensive care unit.

  • continuous renal replacement therapy
  • CRRT
  • hypophosphatemia
  • critical illness
  • ICU
  • mechanical ventilation
  • phosphates
  • Received September 16, 2021.
  • Accepted March 22, 2022.
  • Copyright © 2022 by the American Society of Nephrology
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Clinical Journal of the American Society of Nephrology: 17 (5)
Clinical Journal of the American Society of Nephrology
Vol. 17, Issue 5
May 2022
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Association of Phosphate-Containing versus Phosphate-Free Solutions on Ventilator Days in Patients Requiring Continuous Kidney Replacement Therapy
Melissa L. Thompson Bastin, Arnold J. Stromberg, Sethabhisha N. Nerusu, Lucas J. Liu, Kirby P. Mayer, Kathleen D. Liu, Sean M. Bagshaw, Ron Wald, Peter E. Morris, Javier A. Neyra
CJASN May 2022, 17 (5) 634-642; DOI: 10.2215/CJN.12410921

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Association of Phosphate-Containing versus Phosphate-Free Solutions on Ventilator Days in Patients Requiring Continuous Kidney Replacement Therapy
Melissa L. Thompson Bastin, Arnold J. Stromberg, Sethabhisha N. Nerusu, Lucas J. Liu, Kirby P. Mayer, Kathleen D. Liu, Sean M. Bagshaw, Ron Wald, Peter E. Morris, Javier A. Neyra
CJASN May 2022, 17 (5) 634-642; DOI: 10.2215/CJN.12410921
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Original Article

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Acute Kidney Injury and ICU Nephrology

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Keywords

  • continuous renal replacement therapy
  • CRRT
  • hypophosphatemia
  • critical illness
  • ICU
  • mechanical ventilation
  • phosphates

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