Kidney Week

Abstract: SA-PO892

Pulmonary Artery Catheterization and Coronary Care Unit Location Predict Higher Incidence of Thrombocytopenia in Patients Receiving Continuous Veno-Venous Hemodialysis

Session Information

• Dialysis: Cardiovascular, BP, Volume
  October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• McMahon, Blaithin A., Johns Hopkins University School of Medicine, Baltimore, Maryland, United States

Blaithin A. McMahon,

• Griffin, Jan, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States

Jan Griffin,

• Menez, Steven, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States

Steven Menez,

• Tariq, Anam, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States

Anam Tariq,

• Kyeso, Yousuf, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States

Yousuf Kyeso,

• Chedid, Alice, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States

Alice Chedid,

• Habbach, Amr, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States

Amr Habbach,

• Choi, Michael J., Johns Hopkins University School of Medicine, Baltimore, Maryland, United States

Michael J. Choi,

Background

Thrombocytopenia can occur in as much as 70% of patients receiving continuous renal replacement therapy (CRRT). The extent and temporal relation of thrombocytopenia is poorly understood. We recognized a high incidence of CRRT-related thrombocytopenia in the coronary care unit (CCU) at our institution. The purpose of our study was to compare the incidence of thrombocytopenia in patients receiving CRRT in the CCU and medical intensive care unit (MICU) and identify differences in risk factors for CRRT-related thrombocytopenia.

Methods

We performed a retrospective observational study of all patients admitted to the CCU and MICU of the Johns Hopkins Hospital who received CRRT for any reason between June 2010 to June 2017. Thrombocytopenia was defined as a decrease in platelet count of ≥ 50% within 72 hours of initiation of CRRT. The exclusion criteria included platelet count < 100 x 10⁹ / liter prior to initiation of CRRT, decrease in platelet count of > 30% in the 48 hours prior to initiation of CRRT, duration of CRRT < 48 hours and death within 48 hours of CRRT initiation.

Results

We identified 795 patients who received CRRT in the CCU and MICU over a 7 year time period, 298 in the CCU and 497 in the MICU. 65 patients in the CCU and 67 patients in the MICU met inclusion criteria. The patients were well matched based on age, sex, race, comorbid illness and APACHE II score. There was a significant difference between the rates of those patients with a history of coronary artery disease (CAD) (55.8% vs 21.4%, P<0.001) and congestive heart failure (CHF) (84.9% vs 29.1%, P<0.001) in the CCU and MICU, respectively. Development of CRRT-related thrombocytopenia was seen in 22.5% of CCU patients compared to 13.9% of MICU patients. On adjusted MLoR, the odds ratio for development of thrombocytopenia-related CRRT based on CCU location was 2.5 (95% CI 1.4-4.5, P< 0.005). Patients with pulmonary artery catheterization were more likely to develop thrombocytopenia (OR 2.9; CI 1.1-7.9, P< 0.05).

Conclusion

The incidence of CRRT-related thrombocytopenia appears to be higher in the CCU as compared to the MICU. PA catheterization was significantly-associated with CRRT-related thrombocytopenia and requires further investigation.

Funding

• Private Foundation Support