Kidney Res Clin Pract.  2017 Sep;36(3):240-249. 10.23876/j.krcp.2017.36.3.240.

The influence of hypophosphatemia on outcomes of low- and high-intensity continuous renal replacement therapy in critically ill patients with acute kidney injury

• Kim SY
• Kim YN
• Shin HS
• Jung Y
• Rim H

• KMID: 2416093
• DOI: http://doi.org/10.23876/j.krcp.2017.36.3.240

Abstract

BACKGROUND
The purpose of this study was to assess the role of hypophosphatemia in major clinical outcomes of patients treated with low- or high-intensity continuous renal replacement therapy (CRRT).
METHODS
We performed a retrospective analysis of data collected from 492 patients. We divided patients into two CRRT groups based on treatment intensity (greater than or equal to or less than 40 mL/kg/hour of effluent generation) and measured serum phosphate level daily during CRRT.
RESULTS
We obtained a total of 1,440 phosphate measurements on days 0, 1, and 2 and identified 39 patients (7.9%), 74 patients (15.0%), and 114 patients (23.1%) with hypophosphatemia on each of these respective days. In patients treated with low-intensity CRRT, there were 23 episodes of hypophosphatemia/1,000 patient days, compared with 83 episodes/1,000 patient days in patients who received high-intensity CRRT (P < 0.01). Multiple Cox proportional hazards analysis showed that Acute Physiology and Chronic Health Evaluation (APACHE) III score, utilization of vasoactive drugs, and arterial pH on the second day of CRRT were significant predictors of mortality, while serum phosphate level was not a significant contributor to mortality.
CONCLUSION
APACHE score, use of vasoactive drugs, and arterial pH on the second CRRT day were identified as significant predictors of mortality. Hypophosphatemia might not be a major risk factor of increased mortality in patients treated with CRRT.

Keyword

Acute kidney injury; Continuous renal replacement therapy; Hypophosphatemia; Intensity; Mortality

MeSH Terms

Acute Kidney Injury*
APACHE
Critical Illness*
Humans
Hydrogen-Ion Concentration
Hypophosphatemia*
Mortality
Renal Replacement Therapy*
Retrospective Studies
Risk Factors