Thongprayoon C, Radhakrishnan Y, Cheungpasitporn W, Petnak T, Qureshi F, Mao MA, Kashani KB. Association of Serum Phosphate Derangement With Mortality in Patients on Continuous Renal Replacement Therapy.
Can J Kidney Health Dis 2022;
9:20543581221114697. [PMID:
35923184 PMCID:
PMC9340369 DOI:
10.1177/20543581221114697]
[Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Indexed: 11/17/2022] Open
Abstract
Background:
There is limited evidence on the association of serum phosphate with
mortality in patients receiving continuous renal replacement therapy
(CRRT).
Objective:
To assess the association of serum phosphate with mortality in critically ill
patients requiring CRRT for acute kidney injury (AKI).
Design:
A cohort study.
Setting:
A tertiary referral hospital in the United States.
Patients:
Acute kidney injury patients receiving CRRT from 2006 through 2015 in
intensive care units.
Measurements:
(1) Serum phosphate before CRRT and (2) mean serum phosphate during CRRT were
categorized into 3 groups; ≤2.4 (hypophosphatemia), 2.5 to 4.5 (normal serum
phosphate group), and ≥4.6 (hyperphosphatemia) mg/dL.
Methods:
Multivariable logistic regression was used to assess the association between
serum phosphate and 90-day mortality.
Results:
A total of 1108 patients were included in this study. Of these, 55% died
within 90 days after CRRT initiation. Before CRRT, 3%, 30%, and 66% had
hypophosphatemia, normophosphatemia, and hyperphosphatemia, respectively.
Before CRRT, both hypophosphatemia and hyperphosphatemia were significantly
associated with higher 90-day mortality with the adjusted odds ratio (OR) of
2.22 (95% confidence interval [CI]: [1.03, 4.78]) and 1.62 (95% CI: [1.21,
2.18]), respectively. During CRRT, 3%, 85%, and 12% had mean serum phosphate
in hypophosphatemia, normophosphatemia, and hyperphosphatemia range. During
CRRT, hyperphosphatemia was significantly associated with higher 90-day
mortality with adjusted OR of 2.22 (95% CI: [1.45, 3.38]).
Limitations:
Single center, observational design, lack of information regarding causes of
serum phosphate derangement.
Conclusion:
Most CRRT patients had hyperphosphatemia before CRRT initiation but maintain
normal serum phosphate during CRRT. Before CRRT, hypo- and
hyperphosphatemia, and during CRRT, hyperphosphatemia predicted higher
mortality.
Trial registration:
Not registered.
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