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Published on: August 19, 2020
[Relationship between continuous renal replacement therapy and hypophosphatemia in critically ill children]
1Department of Critical Care Medicine, Children's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai 200040, China.
Insights
Hypophosphatemia frequently occurs in critically ill children undergoing continuous blood purification (CBP). However, phosphorus supplementation appears to mitigate any link between low phosphorus levels and mortality in these patients.
Area of Science:
- Pediatric Critical Care Medicine
- Nephrology
- Intensive Care
Background:
- Critically ill children often require continuous blood purification (CBP) for organ support.
- Hypophosphatemia is a known complication in critically ill patients, but its incidence and impact during CBP in children are not well-defined.
Purpose of the Study:
- To determine the incidence of hypophosphatemia in critically ill children treated with CBP.
- To evaluate the prognosis and mortality associated with hypophosphatemia in this patient population.
Main Methods:
- Retrospective analysis of medical records of 85 critically ill children treated with CBP in a pediatric intensive care unit.
- Serum phosphorus levels were measured at multiple time points: before, during (48-72h, end), and after CBP.
- Phosphorus supplementation was administered to patients with severe hypophosphatemia.
Main Results:
- A high incidence of hypophosphatemia was observed in 78% of patients during CBP, with moderate (48%) and severe (14%) forms noted.
- Serum phosphorus levels significantly decreased during CBP, particularly at 48-72 hours and the end of treatment.
- Higher CBP replacement rates correlated with lower serum phosphorus levels during treatment.
- No significant association was found between hypophosphatemia and mortality after phosphorus supplementation.
Conclusions:
- Hypophosphatemia is a common complication in critically ill children receiving CBP, likely influenced by the CBP replacement rate.
- Phosphorus supplementation appears to negate the potential negative impact of hypophosphatemia on mortality in this cohort.
Abstract:
Objective: To investigate the incidence and prognosis of hypophosphatemia in critically ill children treated with continuous blood purification (CBP). Methods: The medical records of the critically ill patients, who were treated with CBP, admitted to pediatric intensive care unit (PICU) of Shanghai Children's Hospital from May 2014 to April 2017 were retrospectively analyzed. The serum phosphorus levels were tested before CBP, at 48-72 h during CBP, at the end of CBP and on the next day after CBP finished. Phosphorus supplement was given to the children with severe hypophosphatemia. Results: A total of 85 patients met the inclusion criteria. The serum phosphorus levels at the 4 indicated time points were (1.4±0.5), (0.7±0.3), (0.8±0.3), (0.9±0.4) mmol/L, respectively (F=45.21, P<0.05). Among the children, 66 cases (78%) had hypophosphatemia during CBP. The incidences of moderate and severe hypophosphatemia were 32 (48%) and 9 (14%), respectively. There were 41 patients with CBP replacement rates of (35-49) ml/(kg·h), while 44 patients with CBP replacement rates of 50-70 ml/(kg·h). There were significant differences at 48-72 h during CBP, the end of CBP and on the next day after CBP ((0.8±0.4) vs. (0.5±0.2), (1.0±0.3) vs. (0.6±0.2), and (1.1±0.4) vs. (0.8±0.2) mmol/L; t=7.672, 4.060, 14.440, P<0.05). Atotal of 9 cases were treated with sodium glycerophosphate. Among the 85 children, 24 (28%) patients died while 61 (72%) survived. There were no significant differences between the two groups in serum phosphorus levels at the indicated time points ((1.4±0.5) vs. (1.4±0.5), (0.7±0.3) vs. (0.7±0.3), (0.7±0.3) vs. (0.8±0.3), and (1.0±0.3) vs. (0.9±0.3) mmol/L, respectively, P>0.05). Conclusions: Hypophosphatemia is prone to occur during CBP, which probably related to the replacement rate. There was no significant relationship between hypophosphatemia and mortality in critically ill children after giving phosphorus supplementation.
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