Association of Serum Phosphate Derangement With Mortality in Patients on Continuous Renal Replacement Therapy
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)...
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th-mahidol.874162023-06-20T12:37:30Z Association of Serum Phosphate Derangement With Mortality in Patients on Continuous Renal Replacement Therapy Thongprayoon C. Mahidol University Medicine 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. 2023-06-20T05:37:30Z 2023-06-20T05:37:30Z 2022-01-01 Article Canadian Journal of Kidney Health and Disease Vol.9 (2022) 10.1177/20543581221114697 20543581 2-s2.0-85135187717 https://repository.li.mahidol.ac.th/handle/123456789/87416 SCOPUS |
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Medicine Thongprayoon C. Association of Serum Phosphate Derangement With Mortality in Patients on Continuous Renal Replacement Therapy |
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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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Mahidol University |
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Mahidol University Thongprayoon C. |
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Thongprayoon C. |
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Thongprayoon C. |
title |
Association of Serum Phosphate Derangement With Mortality in Patients on Continuous Renal Replacement Therapy |
title_short |
Association of Serum Phosphate Derangement With Mortality in Patients on Continuous Renal Replacement Therapy |
title_full |
Association of Serum Phosphate Derangement With Mortality in Patients on Continuous Renal Replacement Therapy |
title_fullStr |
Association of Serum Phosphate Derangement With Mortality in Patients on Continuous Renal Replacement Therapy |
title_full_unstemmed |
Association of Serum Phosphate Derangement With Mortality in Patients on Continuous Renal Replacement Therapy |
title_sort |
association of serum phosphate derangement with mortality in patients on continuous renal replacement therapy |
publishDate |
2023 |
url |
https://repository.li.mahidol.ac.th/handle/123456789/87416 |
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1781413985160003584 |