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

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

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. Zeroinflated 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, 20.08 to 20.30) fewer days in the intensive care unit and 20% (95% confidence interval, 2 0.12 to 20.32) 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.

Original languageEnglish
Pages (from-to)634-642
Number of pages9
JournalClinical Journal of the American Society of Nephrology
Volume17
Issue number5
DOIs
StatePublished - May 2022

Bibliographical note

Funding Information:
Neyra is currently supported by National Heart, Lung, and Blood Institute grant R01 HL148448-01 and NIDDK grants R56 DK126930 and P30 DK079337. A.J. Stromberg reports consultancy agreements with Doorn Corporation (Louisville, KY), Golden Law Office PLLC (Lexington, KY), and VRTogether (Lexington, KY). M.L. Thompson Bastin reports research funding from the ASHP Foundation and the (Canadian) University Hospital Foundation, serving in an advisory or leadership role at Lediant Biosciences, and speaker fees from Baxter Healthcare. R. Wald reports research funding from Baxter; serving on the editorial boards of CJASN, Kidney360, and Kidney Medicine; and other interests or relationships as a contributor to UpToDate. All remaining authors have nothing to disclose.

Funding Information:
S.M. Bagshaw reports consultancy agreements with Baxter Healthcare Corp., BioPorto Inc., and CNA Diagnostics Inc.; ownership interest in CNA Diagnostics Inc.; research funding from Baxter Healthcare Corp.; honoraria from Baxter Healthcare Corp.; serving in an advisory or leadership role for Baxter Healthcare Corp. (advisory), BioPorto (adjudication committee), CNA Diagnostics Inc. (advisory), and Critical Care (editorial board); and speaker fees from Baxter Healthcare Corp. S.M. Bagshaw is supported by a Canada Research Chair in Critical Care Nephrology. K.D. Liu reports consultancy agreements with AM Pharma, Bio-merieux, BOA Medical, and Seastar Medical; holds stock in Amgen; serving on the editorial boards of American Journal of Kidney Diseases, American Journal of Respiratory and Critical Care Medicine, and CJASN; serving in an advisory or leadership role for the American Thoracic Society and the National Kidney Foundation Scientific Advisory Board; and other interests or relationships with UpToDate. K.D. Liu is currently supported by National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) grant K24 DK1133381. P.E. Morris reports consultancy agreements with Dompe and Medtronic. J.A. Neyra reports consultancy agreements with Baxter Healthcare Inc., Biomedical Insights, and Leadiant Biosciences; speaker fees from Baxter; serving as a section editor for Clinical Nephrology and a guest editor for Critical Care Nephrology in Advances in Chronic Kidney Disease; and serving on the editorial boards of Advances in Chronic Kidney Disease and Kidney360. J.A.

Funding Information:
The authors thank the University of Kentucky CRRT Quality Assurance team for the constructive feedback provided on this work. This work was performed at the University of Kentucky Medical Center.

Publisher Copyright:
© 2022 by the American Society of Nephrology.

ASJC Scopus subject areas

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation

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