Standard treatment for critically ill patients with acute kidney injury (AKI) is continuous renal replacement therapy (CRRT). During CRRT, unless dialysate and replacement solutions are adequately adjusted, electric disturbance such as hypokalemia or hypophosphatemia may occur. A team at Samsung Medical Center in Seoul, Gangham, Korea (the Republic of) developed a protocol to prevent electrolyte disturbance by adjusting dialysate and replacement fluids depending on serial changes in serum potassium and phosphorus levels.
In an analysis of the impact of the new protocol, all adult patients who received CRRT for ≥3 days from 2013 to 2014 (pre-protocol group) were compared with those who received CRRT for ≥3 days from 2016 to 2017 (protocol group). The analysis included the individual coefficient of variation (CV) and the number of abnormal measurement for electrolytes during CRRT. The researchers also compared with frequency of potassium, phosphorus, or magnesium replacement therapy between the two groups.
The analysis included a total of 1456 patients. The two groups were similar in age, sex, and CRRT duration. In the protocol group, the CV of serum potassium was lower (pre-protocol vs protocol: 0.113 vs 0.092; P<0.0001. The protocol group also had lower CV of serum phosphorus (pre-protocol vs protocol: 0.292 vs 0.248; P<0.001). The protocol group had lower event rates of abnormal potassium levels (pre-protocol vs protocol: 0.205 vs 0.083; P<0.001) and abnormal phosphorous levels (pre-protocol vs protocol: 0.406 vs 0.280; P<0.0001). The protocol group also had lower CV of serum magnesium, sodium, and ionized calcium. Application of the new protocol, significantly reduced the frequency of potassium phosphorus, and magnesium replacement (P<0.001).
“Our novel CRRT fluid protocol significantly increased electrolyte stability and consequently prevented electrolyte disturbance during CRRT,” the researchers said.
Source: Boo Hj, Baeg Si, Lee K, et al. Effects of a novel CRRT fluid protocol on electrolyte stability. Abstract of a poster presented at the American Society of Nephrology Kidney Week 2019 (Abstract FR-PO048), November 8, 2019, Washington, DC.