Department of Pharmacy Services, University of Kentucky Medical Center, Lexington, Kentucky.
Department of Pharmacy Practice and Science, University of Kentucky, Lexington, Kentucky.
Clin J Am Soc Nephrol. 2022 May;17(5):634-642. doi: 10.2215/CJN.12410921. Epub 2022 Apr 27.
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 test or a chi-squared test, as appropriate.
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.
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.
在接受连续肾脏替代治疗（continuous KRT）的患者中，常观察到低磷血症。发生低磷血症的患者可能有发生呼吸和神经肌肉功能障碍的风险，因此可能需要延长呼吸机支持。我们评估了含磷与无磷连续 KRT 溶液与接受连续 KRT 的危重症患者呼吸机依赖的关系。
设计、地点、参与者和测量：我们的研究是一项单中心、回顾性、前后队列研究，纳入了在重症监护病房期间接受连续 KRT 和机械通气的成年患者。使用零膨胀负二项式回归和倾向评分匹配来模拟我们的主要结局：28 天无呼吸机天数。使用 t 检验或卡方检验分析重症监护病房和住院时间以及住院死亡率，具体取决于情况。
我们确定了 992 名符合条件的患者，其中 649 名（65%）接受了含磷溶液，343 名（35%）接受了无磷溶液。在多变量模型中，接受含磷连续 KRT 溶液的患者 28 天的无呼吸机天数增加了 12%（95%置信区间，0.17 至 0.47）。与接受无磷溶液的患者相比，接受含磷溶液的患者在重症监护病房的天数减少了 17%（95%置信区间，-0.08 至 -0.30），在医院的天数减少了 20%（95%置信区间，-0.12 至 -0.32）。倾向评分匹配分析中也观察到了 28 天无呼吸机天数的一致结果。两组间的住院死亡率无差异。
与使用无磷连续 KRT 溶液相比，使用含磷连续 KRT 溶液与呼吸机天数减少和重症监护病房住院时间缩短独立相关。
