LAUSR

Learning Objectives: Continuous venovenous hemofiltration (CVVH) is a commonly used form of renal replacement therapy in the intensive care setting. Both acute kidney injury (AKI) and CVVH are associated with electrolyte derangements that can be challenging to manage. Recently, our institution added a phosphate dialysis solution, Phoxillum, to our formulary as an option for CVVH fluid in addition to the bicarbonate based Prismasol products available. We sought to evaluate the impact of the use of Phoxillum in patients who required CVVH when compared to Prismasol with regards to phosphate and glucose management. Methods: This was a single center, retrospective, observational cohort analysis approved by Partners Health Care System Institutional Review Board that included patients who had received a minimum of 24 hours of either Prismasol 4/2.5 or Phoxillum for CVVH from February 2017 to November 2017. Phosphate and glucose levels were monitored daily while on CVVH. Prevalence of hypoglycemia (glucose < 70 mg/dL), hyperglycemia (glucose > 180 mg/dL), hypophosphatemia (phosphate 2.5 < mg/dL), and hyperphosphatemia (phosphate > 4.3 mg/dL) were collected in terms of days of occurrence while on CVVH. Oral and intravenous phosphate repletion requirements were collected for all patients. Results: Sixty patients were included in the analysis for a total of 734 days of CVVH, 211 days in the Phoxillum group and 523 days in the Prismasol group. Prevalence of hypophosphatemia in terms of CVVH days was greater in the Prismasol group as compared to the Phoxillum group (24.9% vs. 6.3%; p<0.0001), and conversely the prevalence of hyperphosphatemia was greater in the Phoxillum group as compared to the Prismasol group (37.0% vs. 27.7%; p<0.0001). There was no difference between the Phoxillum and Prismasol groups in the prevalence of hypoglycemia (10.4% vs. 10.1%; p=0.91) or hyperglycemia (33.3% vs. 34.8%; p=0.25). Patients in the Prismasol group received significantly more days of intravenous phosphate repletion as compared to the Phoxillum group (5.5% vs. 1.9%, p=0.031). Conclusions: The findings suggest that the use of Phoxillum for CVVH may be associated with decreased prevalence of hypophosphatemia and decreased need for intravenous phosphate repletion in patients who require CVVH.