Dr. Pramod Guru

Dr. Pramod Guru (PG), Critical Care Fellow at the Mayo Clinic, Rochester, MN, discusses his abstract for the National Kidney Foundation’s 2014 Spring Clinical Meetings (SCM14), Outcomes of Patients who Develop Thrombocytopenia While on Continuous Renal Replacement Therapy, with Dr. Kenar Jhaveri (eAJKD), eAJKD Editor.

eAJKD: Why don’t you tell us a little about your research and abstract being presented at NKF 2014 Spring Meetings?

PG: Thrombocytopenia as well as acute kidney injury (AKI) is very common in ICU practice. Both AKI and thrombocytopenia at the start of dialysis have been independently associated with poor outcomes. Our study was aimed to prognosticate the impact of thrombocytopenia in CRRT patients. We hypothesized that patients with thrombocytopenia and on CRRT will have significant difference in ICU outcomes in relation to the relative drop in platelet counts.  We retrospectively evaluated ICU patients who had new-onset thrombocytopenia defined as platelet counts <150,000 following initiation of CRRT.  The whole cohort was divided in to two groups depending upon the development of relative fall in platelet counts.  New onset thrombocytopenia is defined as >50% drop in counts after start of CRRT. Out of the total 350 historical cohort, around 41% patients had more than >50% fall in platelet counts.  Similar to other studies we found that severe thrombocytopenia in CRRT patients is more common among females and those who have severe comorbidities as evidence by high APACHE score. To our surprise we didn’t find any difference in the ICU or hospital mortality between the two groups of CRRT patients. Besides the prolonged length of ICU stay with median of 4 days among the patient’s with >50% fall in platelet counts, none of the other outcome variables are found to be different statistically. Given the prognostic importance of the platelet counts on ICU patients, and being an inexpensive and routinely monitored parameters in patients on CRRT; it is worth to prospectively explore its prognostic role in CRRT patients.

eAJKD: Are all CRRT done using heparin in this study or some patients had citrate based protocol?

PG: Most of the CRRT was done on citrate base protocol. Only 3.4 % of patients were on heparin.

eAJKD: Where do you and your group go from here?

PG: We are planning to evaluate the individual role of various patient and dialysis related reasons for new-onset thrombocytopenia and their impact on the CRRT patients who develop severe thrombocytopenia.  So to summarize we would proceed with the following steps:

1. We will complete a sensitivity analysis by exclusion of patients who received heparin.
2. We will complete a series of univariate analyses to identify potential risk factors associated with new-onset thrombocytopenia in CRRT patients. Then will build a multivariate model to predict such thrombocytopenia.
3. In a prospective design we aim to verify our findings in this retrospective analysis including the incidence of thrombocytopenia and its impact on patient outcomes and finally to validate our model. In this prospective study we stratify patients based on the main risk factors to verify their role in new onset thrombocytopenia.
4. In addition, we plan   to evaluate the role of dialyzer in development of thrombocytopenia in ICU patients.

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