Association of Serum Phosphate Derangement With Mortality in Patients on Continuous Renal Replacement Therapy
Issued Date
2022-01-01
Resource Type
eISSN
20543581
Scopus ID
2-s2.0-85135187717
Journal Title
Canadian Journal of Kidney Health and Disease
Volume
9
Rights Holder(s)
SCOPUS
Bibliographic Citation
Canadian Journal of Kidney Health and Disease Vol.9 (2022)
Suggested Citation
Thongprayoon C. Association of Serum Phosphate Derangement With Mortality in Patients on Continuous Renal Replacement Therapy. Canadian Journal of Kidney Health and Disease Vol.9 (2022). doi:10.1177/20543581221114697 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/87416
Title
Association of Serum Phosphate Derangement With Mortality in Patients on Continuous Renal Replacement Therapy
Author(s)
Author's Affiliation
Other Contributor(s)
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.